2. INTRODUCTION

3. WORLD HEALTH ORGANIZATION
(WHO)

5. COLD CHAIN
Vaccines are sensitive to heat and freezing
and must be kept at the correct temperature
from the time they are manufactured until
they are used.
The system used for keeping and distributing
vaccines in good condition is called the
COLD CHAIN.
The cold chain consists of a series of storage
and transport links, all designed to keep
vaccines within an acceptable range until it
reaches the user.

6. COLD CHAIN MANAGEMENT
Maintenance of the cold chain requires vaccines
and diluents to be:
collected from the manufacturer or an airport as soon
as they are available;
transported between 2ºC and 8ºC from the airport
and from one store to another;
stored at the correct temperature (see Figure 3A) in
primary/central and intermediate vaccine stores and
in health facilities;
transported between 2ºC and 8ºC to outreach sites
and during mobile sessions;
kept between 2ºC and 8ºC range during immunization
sessions; and
kept between 2ºC and 8ºC during return to health
facilities from outreach sites.

9. EVALUATION OF COLD CHAIN MONITORING IN
KELANTAN, MALAYSIA
K. Hanjeet, M. S. Lye, M. Sinniah, A. Schnur. Bull World Health Organ. 1996; 74(4): 391–397
• An analysis was carried out on a total of 883 cold
chain monitor (CCM) cards, which had been
attached to batches of poliomyelitis,measles, DPT
(diphtheria, pertussis, tetanus) and hepatitis B
vaccines, during their transport and storage from
the central store in Kuala Lumpur to Kelantan
• 234 freeze watches attached to hepatitis B
vaccines were also analysed
• observation were done at six levels between the
central store and the periphery during
distribution of the vaccines

10. • RESULT:
883 cold chain monitor (CCM) cards : at the
final destination 13.4% of all cards remained
white while a COLOUR CHANGE to blue was
observed in 65% in window A, 16.6% in
window B, and 4.4% in window C; none had
turned blue in window D indicating that the
vaccine had not been subjected to
temperatures > or = 34 °C for 2 hours
234 freeze watches: ALL but 2 had turned
purple, which indicates exposure of the
hepatitis B vaccines to temperatures below
0°C

11. VACCINES
Vaccines are delicate biological
substances that can become less
effective or destroyed if they are:
· Frozen
· Allowed to get too hot
· Exposed to direct sunlight or fluorescent
light

12. APA YANG MENYEBABKAN
VAKSIN ROSAK?
 Tiada penjagaan yang betul
 Semua vaksin hilang potensinya selepas tarikh
vaksin luput walaupun diberi penjagaan yang
begitu rapi
 Faktor-faktor lain :
i. Panas cahaya matahari boleh merosakkan
kesemua vaksin terutama polio, campak & BCG
ii. Pembekuan atau terlalu sejuk akan
mengakibatkan DPT dan tetanus toxoid rosak
iii. Bahan kimia e.g disinfeksi,antiseptik,alkohol
(spirits) dan sabun (detergents ) - suhu yg tidak
mengikut kehendak vaksin yang telah
ditetapkan

13. APA YANG MENYEBABKAN
VAKSIN ROSAK?
 Stabiliti juga terganggu jika aseptik teknik
tidak digunakan dgn betul (terutamanya
sediaan multi dos TT)
 Sediaan multidos dinasihatkan digunakan
selepas sebulan dibuka

14. SEMASA DIANGKUT…..
 Vaccine – perlu diangkut dalam bekas
berpenebat
 Guna – ‘freeze-watch’ dan vaccine monitor
 Jenis bekas – cold-box, flask
Ais kering (dry ice) tidak boleh digunakan
semasa mengangkut vaksin Hepatitis B

15. VACCINE COLD CHAIN MONITOR

16. PENTING!
o Sekiranya tetingkap 1,2,3 & 4
adalah berwarna PUTIH, gunakan
vaksin seperti biasa
o Jika tetingkap 1 hingga 3 berwarna
MERAH sepenuhnya, tetapi
tetingkap 4 masih berwarna
PUTIH, bermakna vaksin telah
terdedah kepada suhu melebihi
10°C
o Jika tetingkap 4 adalah MERAH, ini
bermakna terdapat gangguan pada
‘cold chain’ di mana suhu melebihi
34°C untuk tempoh sekurang-
kurangnya 2 jam.

17. FREEZE WATCH

18. COLD BOX

19. SEMASA DISIMPAN…..
 Asingkan jenis-jenis vaksin dengan jelas
 Biarkan ruangan 1-2 cm antara barisan vaksin/ubat
untuk memudahkan pergerakan udara
 JANGAN letakkan vaksin di rak paling bawah kerana
suhunya lebih tinggi
 JANGAN letakkan sebarang makanan @ minuman –
menyebabkan peti sejuk menjadi panas
 JANGAN letakkan sebarang vaksin di rak-rak pintu
 JANGAN simpan vaksin yang melebihi tarikh luput
 Rekod bacaan suhu 2 kali sehari – pagi dan petang

20. FREEZING
COMPARTMENTS
TOP
MIDDLE
LOWER
MAINCOMPARTMENTS
OPV VIALS
ICE CUBED
BCG
MEASLES
DPT/DT/TT
THYPHOID
HEPATITIS
A
HEPATITIS
B
VARICELLA
DILUENT
NOTHING
IN DOOR
DUAL
THERMOMETER
(TOP SHELF)

21. DOMESTIC
REFRIGERATOR

22. SEMASA IMUNISASI…..
• JANGAN beri imunisasi dibawah
sinaran matahari
• Jalankan pelalian di tempat yang
teduh

23. At a later time, inner square still lighter than
outer circle.
If the expiry date has not passed,
USE the vaccine
At a later time, inner square still lighter than
outer circle.
If the expiry date has not passed,
USE the vaccine
DISCARD POINT:
Inner square matches colour of outer circle.
DO NOT use vaccine
DISCARD POINT:
Inner square matches colour of outer circle.
DO NOT use vaccine
BEYOND THE DISCARD POINT:
Inner square darker than outer ring.
DO NOT use the vaccine.
BEYOND THE DISCARD POINT:
Inner square darker than outer ring.
DO NOT use the vaccine.
√
X
X
Inner square lighter than outer circle.
If the expiry date has not passed,
USE the vaccine
Inner square lighter than outer circle.
If the expiry date has not passed,
USE the vaccine
THE VACCINE VIAL MONITOR
√

24. ALGORITHM TO
ASSESS PROBLEMS
IN TEMPERATURE
READINGS
refrigerator temperature reading is less than
+2ºC or greater than +8ºC

25. First Nations Inuit Health Branch, Health Canada and CDC Vaccine Storage and Handling Toolkit (2005), Resources Section,
National Vaccine Storage and Handling Guidelines for Immunization Providers, Appendices

26. First Nations Inuit Health Branch, Health Canada and CDC Vaccine Storage and Handling Toolkit (2005), Resources Section,
National Vaccine Storage and Handling Guidelines for Immunization Providers, Appendices

30. ESSENTIAL ACTIONS
• Take inventory of potentially compromised
immunizing agents and biologics.
• Isolate potentially elected product into a separate
container (paper bag) marked “DO NOT USE” and
store in a functioning refrigerator.
• Do not return product to malfunctioning fridge until
the unit has been serviced and demonstrated to
maintain +2ºC to +8ºC storage temperatures for at
least 2 days.
• Do not use potentially compromised vaccine until
clear instructions related to their use have been
received by the manufacturers or from stability data
in the product monographs.

31. BACAAN SUHU
• Suhu semasa dibaca pada paras raksa
ketika membaca.
• Suhu yang tertinggi semenjak bacaan
lalu (suhu maksima) yang dibaca pada
indikator di bahagian maksima pada
termometer.
• Bacaan semasa pada bahagian minima
dan bahagian maksima adalah sama.

32. BahagianBahagian
atas kiriatas kiri
(minimum)(minimum)
dari sifardari sifar 
-ve-ve
BahagianBahagian
bawahbawah
(maksimum)(maksimum)
dari sifardari sifar 
-ve-ve
BahagianBahagian
bawah kiribawah kiri
(minimum)(minimum)
dari sifardari sifar
 +ve+ve
Bahagian atasBahagian atas
kanankanan
(maksimum)(maksimum)
dari sifardari sifar 
+ve+ve

33. MINIMUM MAKSIMUM
BACAAN
MAKSIMUM
BACAAN
MINIMUM
BACAAN
SEMASA
RESET

34. TUBERCULIN PPD
(PURIFIED PROTEIN
DERIVATIVE) FOR
MANTOUX TESTING
Tuberculin is a
protein extract from
Mycobacterium
tuberculosis, the
bacteria that causes
tuberculosis. It is
injected just beneath
the surface of the skin
of the forearm to test
if a person has
previously been
infected with M.
tuberculosis or not.
TUBERCULIN PPD RT23 SSI

35. TERIMA KASIH