By Mike Butt, Managing Director at LEC Medical (www.lec-medical.co.uk)
With annual Covid-19 booster jabs almost inevitable, care home lead- ers including Queen’s Nursing Institute Chief Executive, Dr Crystal Oldman, and the chair of the Independent Care Group, Mike Padgham, have made it clear that qualified care home nursing staff could administer vaccines to residents on site.
If your care home has the staff capability and capacity, this would be a logical step to take. However, the question every care home manager should ask themselves first is: “Do we have the correct facilities for storing the vaccine safely?”
The importance of this cannot be overstated. Figures for 2018 show that vaccine wastage had a list price value of around £6.3 million. In terms of doses, about half of the reported incidents were avoidable – with many relating to incorrect storage. This is before Covid vaccines are taken into account.
THE IMPACT OF BADLY STORED VACCINES
The active chemicals in vaccines can change in molecular form when exposed to different temperatures. For example, measles and the combined MMR vaccines could have their potency reduced by higher temperatures, while the Hepatitis B and HPV vaccines are sensitive to temperatures which are too cold. This potential to change applies equally to the Covid vaccines from Pfizer, Moderna and Oxford/AstraZeneca.
Vaccines naturally biodegrade over time and being stored outside their recommended temperature range may speed up the loss of potency. This impact cannot be reversed, and a vaccine may then fail to create the desired immune response and give protection – an unthinkable situation where vulnerable care home residents are concerned. HOW TO AVOID WASTE
The ‘cold chain’ is designed to protect vaccines and other biologics from point of manufacture, through their transportation to pharmacies, where they must be safely stored before being distributed to the locations where they will be administered. During this process, Pfizer’s vac- cine must be kept extremely cold: minus 70 degrees Celsius, whilst Moderna has said that its vaccine needs to be frozen too, at minus 20 Celsius. Once delivered to points of administration – which could soon include care homes – all the currently available vaccines can be stored for up to five days within strict 2 to 8-degree parameters.
Failure to store vaccines according to manufacturers’ strict temperature requirements can invalidate the expiry date and cause manufacturers to disclaim responsibility for any apparent failure of the medicine, as the safety and effectiveness of such medicines can be significantly compromised or unknown.
Celebrating Internatational Nurses Day
SO, HOW CAN CARE HOMES ENSURE COVID VACCINES (AND OTHER HEAT SENSITIVE MEDICINES) ARE STORED SAFELY?
It is vital to note that refrigerators used for the storage of medicines must be designed specifically for that purpose. Standard domestic refrigerators cannot be used, for several reasons, including uneven temperature distribution (as a result of minimal air circulation) and a normal operating range of between 0°C and 10°C. The refrigerator used must be of an appropriate size for the quantity of stock to be stored, i.e. filled to no more than 75% capacity to allow adequate air circulation. It must also be reserved exclusively for the storage of vaccines and other pharmaceutical products and not for food, blood, milk, drinks, or anything else representing a contamination risk.
Care must be taken to ensure the refrigeration unit is sited in a well ventilated room maintained between 10°C and 25C, away from external windows and heat sources e.g. radiators or direct sunlight, and at least 5-10 cm from walls and other units. To ensure its ongoing effectiveness, any vaccine refrigeration unit must be serviced according to manufacturer’s instructions and have its integral thermometer independently calibrated to ensure readings are true. The medical refrigerator must be cleaned regularly, and the internal stock should be stored according to first expiry.
Finally, ensure you have named individuals responsible and account- able for the receipt and storage of the vaccines, and the monitoring and recording of fridge and ambient room temperatures.
Providing in-house Covid vaccination in care homes is a very strong possibility. By embedding safe storage provision and practices from the outset, you will help to ensure that not one batch of vaccines is wasted.