Because vaccines must be stored within fairly precise temperature ranges (the cold chain), health care providers are usually well prepared for vaccine storage problems, from power outages to the failure of a compressor on a vaccine refrigerator or freezer.
All of that preparation isn’t always going to be enough to save your vaccines, or anything else in your office though.
What’s Your Plan for Storing Vaccines During an Emergency?
Fortunately, most times you can keep your vaccines safe if you plan ahead.
In addition to being alerted to random problems that come up, you want to be well prepared for any severe weather, natural disasters, and anything else that might lead to prolonged power outages.
What happens if you have to evacuate your office because of wildfires, a hurricane, or floods?
Can you save your vaccines?
Do you have a generator or battery backup if the power goes?
Do you have enough fuel to run your generator for at least 72 hours?
“If alternative storage with reliable power sources are available (i.e., hospital with generator power), transfer to that facility can be considered.”Impact of Power Outages on Vaccine Storage
Ideally, if you know that there will be a prolonged power outage, you will want to safely transfer your vaccines somewhere that has reliable power.
“Establish a working agreement with at least one alternative storage facility even if you have a generator as backup equipment. Make sure you have 24-hour access to this facility. Hospitals, long-term care facilities, state depots, the Red Cross, fire stations, packing plants, and commercial pharmacies are some of the facilities that may be able to assist you.”Vaccine Storage and Handling Toolkit
While that might sound easy, it means that you already have qualified containers in which you can safely transfer your vaccines and an agreement with an alternative vaccine storage facility.
What if you don’t have an alternative vaccine storage facility?
“If vaccines cannot be stored in an on-site storage unit, they should be kept in the portable vaccine storage unit…”Vaccine Storage and Handling Toolkit
If you are very careful, you might be able to store them safely for a prolonged time in a carefully prepared container, as long as you place a temperature monitoring device close to the vaccines and check/record the temperature each and every hour. Using a calibrated digital data logger that can continuously read and record the temperatures would be ideal.
“To condition, leave frozen water bottles at room temperature for about 30 minutes or place in tap water for three to five minutes until you see liquid inside the bottle. Double-check the bottles while placing them in a cooler with the vaccine to ensure water is visible around the ice. Transport coolers that are filled with CFWBs cannot freeze vaccine.”Graham A. Barden MD, FAAP on Take precautions so refrigerated vaccines don’t freeze during transport
In addition to your temperature monitor device, to safely pack up your vaccines for transport, you will also need:
- a Vaccine Storage Troubleshooting Record to document what is happening
- Hard-sided insulated containers or coolers
- Conditioned water bottles for refrigerated vaccines, which are better than frozen gel packs, as they can have a freezing point that is below 0 degrees Celsius (so conditioned gel packs can still freeze your vaccines…), phase change material gels for frozen vaccines, or other approved coolant materials
- Bubble wrap and corrugated cardboard to use as insulating material between the coolant materials and your vaccines
How long can vaccines be stored in this type of temporary cooler?
It depends, but at least eight hours, at which time you would have to switch out the conditioned water bottles. Of course, the problem you might run into if you don’t have power, is where will you get new frozen/conditioned water bottles to keep using? Fortunately, a properly designed vaccine storage container might hold its temperature for a few days.
“With a solid door vaccine refrigerator and a case of frozen water bottles, you could create your great-grandmother’s ice box by moving the vaccine from the top shelf to lower shelves and putting as many frozen half liter bottles as you can fit on the top shelf and closing the door! I have kept a refrigerator 2-8C for 3 days this way. And since I live in Coastal NC, if a hurricane were bearing down (prior generators), I would preload the top shelf with frozen bottles and go home! The frozen ice bottles would last longer with the refrigerator on without getting too cold. And when/if the power went out, the frozen water bottles would provide the necessary passive cooling to maintain the unit at 2-8C.”Graham A. Barden MD, FAAP on Power Failure and Vaccine Storage – Considerations for Choosing a Generator as Backup Power for Refrigeration
Putting conditioned water bottles on the top shelf of a refrigerator might also keep it cold for a few days if the power goes out, which can be a good solution if you don’t have a generator and don’t want to move your vaccines in a cooler.
Any other options?
“Our advanced technology means that the TempArmour fridge maintains its temperature within the critical 36-46°F (2-8°C) range for up to 6 days during power outages, or incidents when the cord is accidentally unplugged.”
There are actually vaccine refrigerators and freezers that are made by TempArmour that can maintain their temperatures for extended periods of time when the power goes out!
“…contingency plans are only viable if the temperature of the refrigerator or backup containers being used can be monitored for temperature range;”Kosari et al on Power outages and refrigerated medicines: The need for better guidelines, awareness and planning
In the end, once the emergency is over and you get your vaccines back into a working vaccine refrigerator, you should mark them all ‘do not use’ until you can review all of your temperature logs. If there was a temperature excursion, contact the vaccine manufacturers and your state Vaccines for Children representative (if you were using state vaccines) for further guidance.
More on Storing Vaccines During an Emergency
- Handling Vaccine Storage Problems
- Transporting Vaccines Safely
- Which Vaccines Need to be Frozen?
- Which Vaccines Need to be Refrigerated?
- Buying a Vaccine Refrigerator
- AAP – Vaccine Storage: Preparing for and Recovering from Disaster
- AAP Immunization Resources Storage and Handling Series Disaster Planning
- SOAPM Vaccine Storage & Handling Information (requires login)
- Power Failure and Vaccine Storage – Considerations for Choosing a Generator as Backup Power for Refrigeration
- Study – Blackout of 2003: Public Health Effects and Emergency Response
- Study – Power outages and refrigerated medicines: The need for better guidelines, awareness and planning
- Study – Root cause analysis underscores the importance of understanding, addressing, and communicating cold chain equipment failures to improve equipment performance
- CDC – Impact of Power Outages on Vaccine Storage
- CDC – Vaccine Storage and Handling Toolkit
- CDC – Packing Vaccines for Transport during Emergencies
- AAP – Vaccine Storage and Handling
- AAP – Policies and Procedures: Vaccine Loss Due to Disaster
- Emergency Vaccine Storage and Handling Plan Checklist
- Vaccine Emergency Response Worksheet
- Transporting Refrigerated Vaccines
- Transporting Frozen Vaccines
- Take precautions so refrigerated vaccines don’t freeze during transport
- Best Practices for Vaccine Purchasing and Storage: Q & A with Dr. Graham Barden
- AAP – Preparedness Checklist for Pediatric Practices
- AAP –Post-Disaster Considerations for Pediatricians in Practice
- AAP – Hurricanes and Storms: From Preparedness to Recovery, Strategies for a Brighter Future
- Cold Chain Equipment Optimisation Platform Technology Guide
- Evaluation of the Cold Chain Equipment Optimization Platform
- TempArmour vaccine fridge