1. California Dept of Health Services, Immunization Branch Vaccine Storage and Handling Getting It Right!

2. California Dept of Health Services, Immunization Branch California Department of Health Services Immunization Branch Sandra Jo Hammer, RN, MSN, MPH Suzi Bouveron, MPH John A. Hetsko, MPA

3. California Dept of Health Services, Immunization Branch Sandra Jo Hammer, RN, MSN, MPH Nurse Consultant III Immunization Branch California Department of Health Services (510) 540-2198 E-mail: SHammer@DHS.CA.GOV

4. California Dept of Health Services, Immunization Branch Project Background California has long history of encouraging quality vaccine administration, storage, and handling (provider focus) Iced Champagne and Roses (1980’s) video –Updated in 2004 by CDC Vaccine administration video and materials (2000)

5. California Dept of Health Services, Immunization Branch Comfort Measures Poster (English/Spanish) Immunization Techniques Training Video Comfort Measures Take-home Sheet Skills Checklist Immunization Site Map Anatomic Sites Poster Restraint Techniques

6. California Dept of Health Services, Immunization Branch Problem Identification California VFC QAR visits increasingly revealing significant vaccine storage and handling problems; ~20% of VFC visits identified vaccine storage and handling problems. Emergency calls to branch, LHD, field reps Diverse opinions among staff of branch Some abuse is long term, some short More abuse is related to vaccines exposed to temperatures that are 32° F. or lower

7. California Dept of Health Services, Immunization Branch California VFC Quality Assurance Reviews Reviews done by VFC field representatives, LHDs, etc. Diverse groups conducting VFC visits via template format Reviewers training is mainly “on the job”, VPDC, staff meetings, close working relationship with field reps

8. California Dept of Health Services, Immunization Branch Storage and Handling Thermometers –Cheap or inadequate –Broken –Placed in wrong place in the refrigerators and freezers. –Staff unable to read the thermometers Power disruptions –Opening the refrigerator or freezer doors during outages Inadequate or old refrigerator and freezer units

9. California Dept of Health Services, Immunization Branch VFC Approach Affecting and implementing change – work with the practices Be available, replenish vaccine quickly, support Help develop office plan Follow-up Testimonials

10. California Dept of Health Services, Immunization Branch Reviewers Basic Knowledge Temperature infrared guns available; no in- service Refrigerator and freezers – basic refrigeration knowledge very diverse Thermometers – how do they work, what do we need to encourage when practices are purchasing thermometer

11. California Dept of Health Services, Immunization Branch Project Background Storage and handling task force developed – scope of the problem seemed overwhelming Shallow literature and scientific support –General recommendations, MMWR, vaccine product inserts –Need to have resources available for challenges Decision to address the problem in incremental steps, carefully, over time, with partners, branch and CDC support

12. California Dept of Health Services, Immunization Branch Task Force Goals Review all storage and handling materials; develop new materials as need identified Consistent “branding” –logo, colors Develop critical incident report (CIR) and process Develop template responses to CIR that ensure equity and consistency with all providers Tighten the controls and demands of VFC providers regarding storage and handling Enhance knowledge of storage and handling among all branch staff, esp. field staff

13. California Dept of Health Services, Immunization Branch

14. Task Force Goals Enhance knowledge of storage and handling among all branch staff, esp. field staff Prepare for pandemic influenza and storage and handling demands

15. California Dept of Health Services, Immunization Branch Live Satellite Broadcast

16. California Dept of Health Services, Immunization Branch Stated Objectives State three recommendation regarding equipment used in vaccine storage and handling State recommended temperatures for vaccine storage in freezers and refrigerators Identify two items to include when developing a plan for unexpected circumstances

17. California Dept of Health Services, Immunization Branch Objectives (cont.) Explain some vaccine storage and handling procedures that might be different for pandemic influenza Non-stated objectives : –Envisioned this to be a unique expansion of the basic CDC vaccine storage and handling video for QA staff training –Introduce a few updated materials and concepts.

18. California Dept of Health Services, Immunization Branch Target Audience VFC program and field staff Immunization program Coordinators Public health professionals Vaccine manufacturer field staff Anyone interested in quality assurance of vaccine delivery and administration

19. California Dept of Health Services, Immunization Branch Process Script and approvals Professional set Cast Taping (studio and remote) Live session Editing Production

20. California Dept of Health Services, Immunization Branch

22. VFC office MUST check temperature twice a day Use this temperature log Keep them on file for a year

23. California Dept of Health Services, Immunization Branch Recommended Temperatures Refrigerator 35 ° - 46 ° F OR 2 ° - 8 ° C Freezer (varicella) + 5 ° F or colder OR -15 ° C or colder

24. California Dept of Health Services, Immunization Branch

25. What Did We Learn? None of us had a really good understanding of refrigeration Thermometers come in many varieties Over emphasis on keeping vaccines cold kept reoccurring Satellite production is an intense project

26. California Dept of Health Services, Immunization Branch

27. Next Steps Critical indicator sheet for the incident report Identify quality dual control refrigerators Update our VFC program manual –? Signed storage and handling capability document (like varicella) –Requiring offices to send the temp logs with reorders

28. California Dept of Health Services, Immunization Branch Long Term…What is Needed Greater depth of scientific literature Vaccine vial external freeze indicators Less emphasis on cold and more on harm of freezing

29. California Dept of Health Services, Immunization Branch Moderator Sandra Jo Hammer, RN, MSN, MPH Panelists and Speakers Bill Atkinson, MD, MPH Debbie Buchmiller Kandi Buckland, RN Judi Camacho, RN, PHN, BSN Joy Gladden John Hetsko, MSN Doug Lees, MPA Beth McCarthy Debbie Morgan Travis Nelson Sandra Ross, RN, BSN Thomas Smith Pam Sola, RN Eileen Van Reusen Executive Producer Marcy Connell Jones Associate Producers Suzi Bouveron, MPH Deborah Keltner Violet Macias, M.Ed., M.S. Producer Craig Bentley

30. California Dept of Health Services, Immunization Branch Imageworks Production Coordinator Sandra Torres Executive Producer, KPBS Fabiola Franco Content and Technical Advisors Bill Atkinson, MD, MPH Howard Backer, MD, MPH Mary Beckhelm, RN Suzi Bouveron, MPH Judi Camacho, RN, PHN, BSN Jan Campana, RN Sandra Jo Hammer, PHN, MSN, MPH John Hetsko, MSN June Howe Sue Hunt, RN Marcy Connell Jones Deborah Keltner Pat Kirby, RN Beth McCarthy Mary Mulholland, RN Jack Nemecek, MBA Diane Peterson Mary Reynolds, MPH Thomas Smith

31. California Dept of Health Services, Immunization Branch Content and Technical Advisors (Cont:) Donna Weaver, RN, MN Deborah Wexler, MD Production Assistants Patti Holsclaw, MHA Walt Lasota Monica Manzano Janet Macasieb Natalie Nakahara, MFA Jeff Rossetti Christine Sadorra Kate Spilis Jeff Woo Special Thanks Sutter Clinic North County Central Health Clinic ***************************************** Produced at the studios of KPBS Television San Diego, California

32. California Dept of Health Services, Immunization Branch Materials available from: www.CDLHN.COM

33. California Dept of Health Services, Immunization Branch