In May 2014, the CDC released the Vaccine Storage & Handling Toolkit, a 110-page document that provides significant guidance on best practices for storing and handling vaccines (http://www.cdc.gov/vaccines/recs/storage/toolkit/storage-handling-toolkit.pdf). Notably, The Joint Commission recommends the CDC guidelines as an excellent resource on the use, storage, and handling of vaccines, making it all the more important to ensure adherence to these guidelines. 

The extensive resource section at the end of the toolkit includes printable warning signs, shipping labels, posters, checklists, and work sheets, as well as conversion tables, sample inventory records, and emergency management resources, which provide an excellent starting point for form development. Some of the key elements addressed in the guidelines are elucidated below:

Refrigerator Placement
Given the significant dollar value of the contents within a pharmacy’s refrigerators and freezers, the placement of these units should not be an afterthought. Rather, they should be carefully integrated into the room design, not only to ensure ease of access and good workflow, but also to extend the life of this equipment. Refrigerators should be placed at least 4 inches from the wall, and there should be no obstruction of the unit’s motor compartment. Likewise, refrigerators should be a minimum of 1-2 inches above the floor. 

When purchasing a new unit, plan to run it for one week while taking temperature readings at least twice per workday. The morning temperature readings should include both the minimum and maximum temperature within the unit. Only when the effectiveness of the unit has been established with a week’s worth of temperature readings should product be transferred in. 

Water bottles (and coolant packs for freezers) can be used to help maintain stable temperatures in a partially filled refrigerator. Water bottles serve a dual purpose as they can be placed in the areas of the refrigerator where a temperature excursion is most likely to occur (eg, on door racks, the top shelf) in order to keep these areas from being used for drug storage. 

Vaccine Storage
Discontinue the use of dorm-style units. Under no circumstances are VFC vaccines to be stored in dorm-style (or bar-style) refrigerators due to their intrinsic severe temperature control and stability issues. Reflecting these concerns, CDC recommends the use of purpose-built pharmaceutical, stand-alone units. In other words, avoid using household or commercial combination units that have the freezer compartment located within the refrigerator. 

Pharmaceutical-grade units are available in a variety of sizes from compact, under-counter models to large stand-alone units to meet the various needs of different operations. To determine the size refrigerator or freezer appropriate for your facility, consider the space necessary to store all of the vaccines required during the busiest time of the year (eg, flu season) without crowding, and then budget for sufficient space to store water bottles (in refrigerators) and frozen coolant packs (in freezers) to ensure the maintenance of stable temperatures. 

Frost-free freezers with automatic defrost cycles save time and money. With such units it is unnecessary to have a second unit on hand to store medications during the regular, time-consuming defrosting procedures required of manual defrost freezers. 

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Coming soon in PP&P
Developing an Emergency Plan, in the event that refrigeration storage conditions are compromised.