Practice nurses best protect the vaccine cold chain in general practice

Abstract

Objective: Maintenance of the vaccine cold chain is integral to administering potent vaccines thereby protecting individuals and communities against vaccine preventable diseases. Previous studies have highlighted threats to vaccine cold chain integrity. The aim of this study was to assess vaccine cold chain integrity and to identify local factors affecting vaccine cold chain integrity in Hunter general practices, where approximately 85% of vaccines are administered.

Design: A quasi experimental research design was used to conduct a site audit of general practice vaccine storage facilities in both urban and rural areas of the Hunter region of New South Wales. Practice staff who handled vaccines completed a practices and knowledge questionnaire during the audit visit.

Setting: General Practice.

Subjects: This study was an area‑wide survey of all Hunter general practice immunisation service provider sites (n=256) where an audit was conducted of all vaccine refrigerators in use at the time of the audit, and one questionnaire per site was completed with respect to the cold chain management of all vaccine consignments delivered within the previous three months (n=924).

Main Outcome Measures: Main outcome measures were adherence to acceptable vaccine cold chain management practices as identified by National Health and Medical Research Council guidelines and maintenance of vaccine refrigerator temperatures within the World Health Organization’s (WHO) recommended range of 2°C and 8°C.

Results: A key finding from this study was the positive influence of general practice nurses on general practices achieving vaccine cold chain integrity as defined by WHO. Ninety‑eight percent (98%) of general practices where a general practice nurse was employed maintained vaccine cold chain integrity whereas only 42% of general practices where no general practice nurse was employed (95% CI: 10, 58) achieved the same result.
Two types of vaccine refrigerators were identified in Hunter general practices; these were non‑bar type and bar‑type. Of 150 non‑bar type refrigerators in Hunter general practices 97% operated within the safe temperature range for the storage of vaccines, while only 58% of the bar‑type fridges maintained acceptable temperatures for vaccine storage (95% CI: 8 ‑ 69).

Conclusions: Study findings highlighted the value of employing general practice nurses in general practice in relation to maintaining vaccine cold chain integrity, and encouraging such nurses to become authorised immunisers so they can participate in ongoing immunisation education. The study findings supported the argument to outlaw bar‑type refrigerators for storing vaccines as these posed an unacceptable threat to vaccine cold chain integrity.