TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. mpacque
  2. Supply chain and logistics
  3. Saturday, 15 June 2013

Oxytocin is a lifesaving drug - it is one of the 13 commodities on the list of the United Nations Commission on Life-Saving Commodities for Women and Children. - See more at:

http://everywomaneverychild.org/component/content/article/1-about/409-un-commission-sets-out-plan-to-make-life-saving-health-supplies-more-accessible#sthash.yorz7nul.dpuf

Oxytocin is temperature sensitive and in several countries studies have demonstrated that the product has lost some, to most of its potency by the time it reaches the women who need it most (those that give birth in remote areas.) In many cases this can be attributed to exposure to high temperatures during transport or storage (e.g. in clinics without air conditioned storage rooms)

On the other hand in some peripheral health centers oxytocin is stored in the cold chain and midwifes assure that it is available in the delivery room by putting it in the cold boxes they use for storing vaccines such as VAT and BCG. However, if the oxytocin has reached the health center outside of the cold box the product may have lost some or all of its potency.

What would be the dis-advantage of assuring that oxytocin is included in the cold chain from the point of entry of the country till it reaches the delivery room? Are there any countries who currently have oxytocin in the cold chain?

Please share your experience and thoughts.

Thank you,

Michel

PATH

mpacque Accepted Answer

WHO and UNICEF have come out with a clear statement about including cold sensitive commodities such as oxytocin in the cold chain. Please see:

http://www.unicef.org/health/files/EPI_cold_chain_WHO_UNICEF_joint_statement_A4_rev2_5-14-15_(3).pdf or attachment.

Hopefully this will contribute to better practices and safe lives

 

Michel

Attachments (1)
  1. more than a month ago
  2. Supply chain and logistics
  3. # 1
John Lloyd Accepted Answer

Oxytocin leads call to expand Vaccine Cold Chain to other medicines. I think that this debate on Oxytocin in the Vaccine cold-chain is very important. Oxytocin is the first temperature sensitive medicine to receive serious global-level attention to the feasibility of sharing cool storage with vaccine. This question comes at a time when the supply and distribution of temperature-sensitive medicines for non-communicable diseases, such as insulin for diabetes, is undergoing expansion at orders of magnitude, far greater in absolute capacity than vaccine. Whether these medicines are regulated for storage at controlled room temperature (+15C to 25C) or for refrigeration standard (+2c to +8C) it is clear that temperature control will be needed at each step of distribution in parallel to vaccine. The design of each country system, the level and extent of integrated features will vary according to each country situation.

The pace of integration will depend on how issues such as the following are decided and how confident system managers can be in compliance and quality:

  • Medicines share the same refrigerator or cold room, or stored in different appliances?
  • Product labelling of vaccines and medicines clear enough to assure safe, correct handling?
  • Medicines stored separately from vaccines, or together in the same space?
  • Medicines accessed more/less frequently than vaccine by more/less authorised health staff?
  • Medicines delivered more/less frequently than vaccine?
  • Alarm systems against freezing/heat exposure for medicines same or different to vaccines?
  • Switchable operating temperatures needed (+15C/+25C, +2C/+8C)
  • Reliability of timely deliveries (as planned) sufficient for both medicines and vaccines, or just medicines?
  • Administrative control, order tracking, authorisation, trouble shooting can be integrated?

Ideally, the same type of refrigerator could be used either for vaccine or for medicines to simplify re-allocation of stock between appliances. The storage requirement will in most cases justify separate refrigerators for vaccines and medicines.

Answering these questions and I’m sure you have more, will require country by country assessment, negotiation and regulation but in the meantime, some practical steps at global level are needed to provide an ‘enabling’ environment in which shared cold chain is identified as an option. These suggestions are in addition to those listed in post 18 03/02/2014 Lydon.

  1. Review suitability of existing PQS Performance specifications for storage of medicines
  2. If outcome 1. is negative, develop a draft Target Product Profile for refrigerators storing vaccine or medicines with sufficient autonomy from the energy supply to assure continuous cooling for >20hours. Include the required temperature/energy recording functionality.
  3. Draft Standard Operating Procedures (SOPs) for combined management of temperature sensitive medicines and vaccines. Debate, refine and test training materials in the field.
  4. Review outcome of 1. and 3. with internal WHO programme divisions, European, US and international standards calling for national procurement classification of ‘Refrigerators for the Storage of Vaccines and Medicines’ as medical equipment. Publish rationale for new classification of refrigerators.

 

  1. more than a month ago
  2. Supply chain and logistics
  3. # 2
Patrick Lydon Accepted Answer
I've just returned from a trip to Togo where fridges in the 8 districts I visited in the “Region du Centre” had a host of temperature sensitive products in the vaccine cold chain including Oxytocin, HIV test kits, bacterial antigens, anti-venoms, insulin…Other informal reports from colleague suggests Oxytocin was seen in the vaccine cold chain of Benin, Mali, Niger, DR Congo, Tanzania, and Vietnam. Is it that counties are moving faster in this direction than the global community? and this is an example of where change management is really needed at international level rather than country level?
  1. more than a month ago
  2. Supply chain and logistics
  3. # 3
Patrick Lydon Accepted Answer

For those of you that haven’t had a chance to follow the latest discussion on IAPHL, I provided below a second recap of the discussions and some thoughts on next steps. Very best, Patrick.

*******

Dear IAPHL Friends,

Many thanks for those of you that have continued to participate in this discussion. As we enter the last week on this topic, I thought I would reflect on some of the additional points made, and solicit your inputs on how the international community of stakeholders could move this agenda forward.

[1] Some further reflections:

Oxytocin potency loss risk

On the topic of potency loss, an interesting study from the New England Journal of Medicine was shared on the effects of freezing (http://www.nejm.org/doi/full/10.1056/nejmc1209761). The results show that the potency of Oxytocin is largely unaffected after being exposed to either (a) continuous freezing temperatures of ?5°C, ?20°C, on ice, and on dry ice for a period of 7 days, or (b) multiple cycles of freezing and thawing during a period of 5 days. The study concludes that health workers can be reassured that Oxytocin can be safely used in the event of accidently freezing in the cold chain either during storage or transportation.

This is a great advantage of Oxytocin over many of the new vaccines being used in EPI. Temperature monitoring studies have shown that 35% of EPI vaccines are exposed to extended periods of freezing in the cold chain. This is a real concern. Vaccines that lose potency from freezing represent about 70% of the value of vaccines procured through UNICEF (the main procuring agency for vaccines in the world). The more traditional EPI vaccines like Polio, need to be kept in freezing temperatures, and others like BCG and Measles can be frozen without loss of potency given that they come in a lyophilized (freeze-dried) presentation. Does this mean that Oxytocin should be kept with the EPI vaccines that are not freeze sensitive like Polio? Perhaps not. But it may mitigate the risk of confusing the products in the cold chain between only Polio and Oxytocin. It is something to think about? I could help justify where in the supply chain integration could happen.

Cold chain capacity risk

On the topic of cold chain capacity, I didn’t pick up on any new insights on this. Instead, I would like to share some that relate to the Effective Vaccine Management (EVM) assessments that have been conducted by WHO and UNICEF in approximately 70 countries since 2010. The EVM assessment is essentially a continuous quality improvement process that is recommended to countries to ensure their vaccine supply chains meet minimum standards at all levels of the in-country system (national, sub-national and service levels) and according to 9 criteria (vaccine arrival, temperature control, storage capacity, quality of the infrastructure and it’s maintenance, vaccine management, distribution, stock management, LMIS…). A recent WHO analysis of the data from 65 low and lower-middle income countries revealed that only 1 country met all recommended standards at all levels of their supply chain. This is a key concern in EPI given that for vaccines, the state of the supply chain has numerous shortcomings. When considering Oxytocin in the vaccine cold chain, the state of the vaccine supply chain is something that needs to be considered very carefully.

Implementation risks

While the first few weeks of discussion had a strong focus on the risks of potency loss from not having Oxytocin in the cold chain, and the risk that the vaccine cold chain isn’t planning necessarily for the capacity needs for such time and temperature health products, the past few weeks has seen more inputs on the implementation risks.

The main take home message is that there isn’t a one-size-fits-all solution. Implementing a strategy to include Oxytocin in the vaccine cold chain is not one that may be advisable in all setting and countries. A tailored approach will be needed and on a country by country basis. For the majority of countries that are not already implementing such a strategy, certain pre-conditions prior to implementation ought to be required and monitored to gauge country-readiness for such a policy change. In those countries that are implementing, additional tools and methods are most certainly required. And particularly to avoid any risk of confusion of products in the cold chain. The case of were the diluent for a lyophilized vaccine (BCG) was accidently used was cited as an example that led to a fatal outcome.

[2] Ideas for next steps:

So where does this leave us in moving forward? As we begin to close down this discussion, it would be good to reflect on where to go next, and to ensure that all the great inputs from the IAPHL community can be brought forward to those working on Oxytocin in the cold chain as part of the UN Commission on Life Saving Commodities. Although I know for a fact that many are tuned into this discussion even if they’ve been shy to join in.

Picking up on the ideas of many of you, I’ve bulleted below what can constitute the beginnings of a list of next steps forward. These are listed in no particular order:

  • Document the specific experiences in countries that have already integrated Oxytocin in the vaccine cold chain (in settings where it has worked well and where it has not worked so well) to understand the reasons for doing so and understand what worked and what didn’t work. The ultimate idea is to draw lessons learned from selected countries that are already implementing a practice of Oxytocin in the vaccine cold chain
  • Document the specific reported incidents where Oxytocin in the cold chain led to a bad outcome, and undertake the root-cause analysis.
  • Conduct one or two pilot projects in countries to implement Oxytocin in the cold chain and fully evaluate the good, the bad and the ugly.
  • Define the segments of the supply chain that could benefit from integration. In other words, should integration occur at national level and then vaccines/Oxytocin get split out into separate distribution chains between sub-national and service levels. Or should integration occur only at the last mile and not at national level? A mix between the two? The idea is to understand what model of integration would be advisable in what setting.
  • Forecast the combined needs for EPI vaccines and Oxytocin for the next 5 years (or up to 2020 for example) against the available and planned capacity in the vaccine cold chain.
  • Develop a framework for assessing country readiness to include Oxytocin in the cold chain.
  • Develop a list of issues, risks and mitigation strategies of including Oxytocin in the cold chain.
  • Work at global level on product presentation and packaging that can mitigate risk of confusion with vaccines.
  • Develop global guidance and recommendations and work with normative agencies and partners at regional/country level to support policy change.
  • Conduct training and capacity building activities to ensure a smooth change management for health workers in implementing a practise of Oxytocin in the cold chain.

This is certainly not an exhaustive list and we’d appreciate any further ideas, thoughts and inputs before we close the discussion at the end of the month.

  1. more than a month ago
  2. Supply chain and logistics
  3. # 4
Patrick Lydon Accepted Answer
In case some of you are interested, a recap of the first week of discussions on the IAPHL is provided below including a background document attached. Very best Patrick ******* Dear IAPHL Friends, Many thanks for all of you that have participated in this discussion so far. I’ve been thoroughly enjoying reading your exchanges on the topic of Oxytocin in the cold chain. It’s been great to see the very passionate and rich posts submitted by members. Yesterday closed the first week of the discussion and I thought I would reflect on some of the points made; share some additional information and thoughts from an EPI perspective; a tee-up a few questions for week two. So here are my musings from week one. It was interesting to learn (from those of you that shared country experiences) that the practise of including oxytocin in the vaccine cold chain is occurring in some settings. It’s probably more widespread than we know, and is a reflection that some countries are seeing the value in doing so, despite any specific policy or recommendation for or against it. That said the vertical nature of EPI over the past four decades has inherently drilled into the psyche of health workers and practitioners in the field that the vaccine fridge is exclusively for EPI vaccines, even if WHO guidelines from EPI aren’t specific about this point. In fact, the very first manuals developed by the EPI department in WHO in the mid-1980s were entitled: “Cold Chain and Logistics for Primary Health Care”. In these guidelines, the cold chain was not viewed as only for vaccines, but for vaccines and any temperature sensitive essential medicine for PHC. The more recent manual entitled “Immunization in Practise” (or IIP) also developed by WHO, does stipulate that if other products need to be stored in the vaccine refrigerator at service delivery levels, these products need to be clearly labelled and organized in the fridge. This is common sense, although we know that in the field, common sense doesn’t always prevail. Failure to comply with this simple rule led to some reported accidents where health workers inadvertently injected children with another product causing harm or death. Fortunately these are few and far between incidents but enough that this needs to be at the forefront of the discussion. The whole question about safety risks of oxytocin in the vaccine cold chain is fundamental irrespective of all the other benefits. But what were some of the risks expressed in week 1 on this question of oxytocin in the cold chain? I’ve tried to group these by three main themes: • Oxytocin potency loss risk One set of comments related to the oxytocin potency loss risk and reduction in shelf life from being stored at ambient temperatures rather than in a cold or controlled temperature chain. An unintended consequence is that health workers at the service delivery levels may feel the need to over-compensate for the loss of potency (or perceived loss of potency) by injecting more oxytocin than the usual amounts. This of course raises the question of wastage brought up by some members. Based on the observations in Ghana that some of you shared, the failure to keep oxytocin in the cold chain was attributed to those managing and distributing oxytocin (either central medical store / private sector) and who aren’t able to ensure that the product is stored between 2-8 degrees Celsius thought the in-country supply chain. Linked to this, some of you have raised the very pertinent questions about the stability profile of oxytocin and the available evidence that exists on potency / shelf life loss at different temperatures. While some commented that exposure to excessive heat can results in a loss of potency, others suggested that oxytocin maintains potency and effectiveness at higher temperature but that the shelf life is reduced from the regular 2 or 3 years. This led some of you wondering if we need to “keep our cool” about transporting and storing oxytocin at higher temperatures. Indeed, if potency is maintained a higher temperatures and only shelf life is affected, one is then able to have the flexibility to work within the boundaries of a relatively long shelf life of the product without necessarily requiring a cold chain. Others indicated that new formulations may be available in the future that will limit the need for cold chain. Given the number of questions on this topic, I’ve attached a document that was produced recently by PATH. In this 10 page document, the existing evidence is nicely compiled. • Cold chain capacity risk A second set of comments related to the cold chain capacity risk. Adding oxytocin to the vaccine cold chain is based on the premise that there is excess capacity in the EPI cold chain. This capacity relates to both storage and transport cold chain capacity. As some of you pointed out, during vaccination campaigns, there is little or no excess cold chain capacity. In the period’s in-between campaigns, there can be excess capacity in the system but often at the lower levels of the supply chain. But how long will this excess capacity be available? With the availability of funds from GAVI to introduce new vaccines, many countries are lining themselves up to introduce pneumococcal, rotavirus and HPV vaccines in the coming years. These are relatively bulky products in comparison to the basic EPI vaccines like polio or measles. In addition, one needs to plan for both the oxytocin and the infusions as mentioned by one of you. This can potentially be a substantial volume of product to store in the vaccine cold chain and will, of course, depend on the packaging and presentation of oxytocin as others mentioned this week. A related risk is on the quality of the storage capacity. Recent assessments done in EPI have shown that the existing cold chain infrastructure is old and becoming obsolete in most low and lower-middle income countries. Many refrigerators are no able to maintain the correct temperature ranges and freezing is a growing concern. Does oxytocin loose potency from freezing? Is this also a concern? • Implementation risks A third set of comments related to the implementation risks of oxytocin in the vaccine cold chain. In no particular order, some of you shared interesting thoughts on: (a) The coordination between programmes: Given that oxytocin and vaccines are managed separately by separate programmes what are the coordination risks? Likewise, the supply chain is usually managed by different entities (government run for vaccines and central medical stores for oxytocin). If oxytocin were to be included in the vaccine cold chain, how would this work in practise? Would EPI be expected to store and transport oxytocin in the vaccine supply chain? How can this be managed and coordinated among the different programmes? This is certainly not a trivial question. (b) The human resource capacity: The risk of oxytocin being confused with other products in the fridge is high. As mentioned, there have been instances of product confusion happening in the field. Health workers at facility level tend to be expended across multiple maternal and child health programmes and the practise of having oxytocin in the vaccine cold chain (whether formally or informally) will require them to have clear guidance and training on how to safely and effectively implement this practise. This would be something required for service level. But does the global level community also need to work on product packaging and visual cues that can mitigate the risk of product confusion in the field? These were some of the main take home messages I got from the first week of discussion. There were many other ideas put forward that I couldn’t include in this short summary. Apologies to those that haven’t seen some of their thoughts represented. And if this is the case, please share these again. For WEEK TWO, it would go good to drill deeper into the “how”. Let’s assume for a moment that the benefits of storing oxytocin in the vaccine cold chain outweigh the risks, and storage capacity in the vaccine cold chain isn’t a constraint, then... How can these benefits be achieve in countries? What would be practical steps forward to implement and roll out such a strategy? What further evidence is needed? I look forward to the discussions this week; your views on these new questions (and the older ones too); or hearing any reacting to my musings from week one. Very best Patrick
  1. more than a month ago
  2. Supply chain and logistics
  3. # 5
Patrick Lydon Accepted Answer
Moderated discussion on IAPHL website covers oxytocin in the vaccine cold chain[color=#336699][/color] The International Association of Public Health Logisticians (IAPHL) is hosting a moderated discussion on the integration of oxytocin in the vaccine cold chain. This discussion is being facilitated by Patrick Lydon (WHO), Benjamin Schreiber (UNICEF) and Daniel Thornton (GAVI Alliance), and can be accessed on the IAPHL listserv website. https://knowledge-gateway.org/iaphl/discussions/90c05401 While discussions on the integration of oxytocin have been taking place on the TechNet forum for some time, by widening the conversation to include IAPHL members we hope to ensure that public health supply chain communities outside of immunization are involved in this important debate. We also hope that this cross-posting will help to better connect members of the two communities. Read more about TechNet’s collaboration with other public health supply chain communities: http://www.technet-21.org/forums/default-topic/3249-technet-launches-collaboration-with-public-health-supply-chain-communities#p4631 The discussion on oxytocin is timely: with the launch of the UN’s Every Women, Every Child initiative, and the ambitions to scale up the use of oxytocin to prevent and treat postpartum hemorrhage in women, questions are re-surfacing as to whether the vaccine cold chain could be leveraged to store oxytocin at service delivery levels. Oxytocin is a time- and temperature-sensitive product whose efficacy and shelf-life can increase significantly when stored at 2-8o C. Studies have demonstrated that significant loss of potency occurs from exposure to high temperatures during transport or storage, and by the time it reaches the women who need it most. The opportunity to store oxytocin in the vaccine cold chain would have far reaching benefits to achieving maternal mortality reduction goals. But how can this be done in practice? What are the risks? And what is the current thinking from those working on immunization in WHO, UNICEF and GAVI? On the eve of the 40th anniversary since the launch of the Expanded Programme on Immunization (EPI) in 1974 by the World Health Assembly, WHO, UNICEF and GAVI are discussing the possibilities of moving to a more integrated vaccine supply chain as a way to achieve both child and maternal mortality reduction objective that are key goals of the Global Vaccine Action Plan. Perhaps Oxytocin is the pathfinder product for segmented integration if it could be stored in the vaccine cold chain? Before we can get to a point where specific policy recommendations and strategies can be made, the first step is to gather all the necessary evidence available. And some of this we hope will come from you. We need your help! Anecdotal evidence highlights that several countries are storing Oxytocin in the vaccine cold chain. That said: • What are the risks and benefits of a strategy to include oxytocin in the vaccine cold chain? • What kind of experiences have countries encountered when they have stored oxytocin in their supply chains? These are just some of the questions we are asking the IAPHL community. Through our exchange we would love to hear your input and experience. To join the moderated discussion on the integration of oxytocin in the vaccine cold chain, you will need to register on the IAPHL website. Once you’re registered you will receive new posts by email. To respond to a post, simply reply to the email and every member of IAPHL will receive the post. You can visit the IAPHL website here: http://iaphl.org/
  1. more than a month ago
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  3. # 6
Thank you for this topic. But we know that it is dangerous to put any medication with vaccines. Once a nurse administered insulin instead of DTP vaccine and killed 2 children so it is very dangerous.
  1. more than a month ago
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prabirkc Accepted Answer
This is a good start. If there is a policy to integrate storage- in particular cold chain- there needs to be a set of policies at all levels. An important issue is the training of the cold chain handler of this integrated chain at field level. Currently the vaccine cold chain is handled by non-health staff or auxiliary nurses. They have been given training on vaccine handling in many places. If other medicines are stored, a pharmacist should handle the cold chain. They will need updating on cold chain. The other cadre- auxiliary nurses could also do it- they will need product specific instructions. Officially they should have been taught about oxytocin- but in practice a refresher training would be sensible. The non-health staff could be upgraded but this would be a longer process. Training manuals should be in place in regional languages and training at each level should start before attempting integration at that level (I guess some national warehouses are also separate)
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mpacque Accepted Answer
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mpacque Accepted Answer
I have attached a document on oxytocin in the EPI cold chain that WHO/UNICEF in collaboration with the UN Commission for life Saving Commodities and partners like PATH and USAID put together for circulation during the Global Health Supply Chain Summit in Ethiopia this week. This 2 pager is a very nice synopsis of the issues related to expanding the use of the cold chain and the way forward with integration. Michel
  1. more than a month ago
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  3. # 10
Satish Accepted Answer
Ref.: observations on inputs of Prabir Chatterjee and Anthony Battersby and others on use of vaccine refrigerators for other vaccines also. Presently I strongly consider that vaccine refrigerators and vaccine cold chain system should exclusively be used for storing/transporting vaccines used in national immunization program. These should not be used for storing of oxytocin/anti rabies serum/anti snake venom or other medicines which are also required to be kept at low temperatures. The accidental use of such items have lead to fatal results which are well documented. 2. The preposition of use of private sector like coca cola for vaccine handling does not appeal though it may be more cost-effective. One mishandling of vaccine derails the whole public health program. Moreover enough experience and expertise is now available at all levels for vaccine handling by the 'system'. Thanks Dr. S.C.Gupta, Jaipur, India (Ex-State Immunization Officer,Rajasthan, India) e-mail: scgupta1scg@gmail.com Mobile: 919413417608
  1. more than a month ago
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  3. # 11
prabirkc Accepted Answer
Very true. Vaccine cold chains are better used for vaccines- and possibly Anti Rabies and anti-snake venoms are more logically kept in this cold chain than oxytocin Oxytocin could have effects on a pregnant woman who comes for TT for instance and it is thought that even qualified doctors have made mistakes when muscle relaxants were kept in the vaccine chain. Insulin accidents are also said to have happened at least once.
  1. more than a month ago
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  3. # 12
TechNet Admin Accepted Answer
Admin
Is it known what the effect on BCG vaccine reconstituted with oxytocin is? Does the vaccine still work? For many years the standard has been that vaccine refrigerators only stored vaccines. There have been cases where children have been given Swiss Berna insulin instead of DPT and have died as a result. If there is now to be a policy that drugs other than vaccine may be stored in a vaccine refrigerator then there need to be some policies and operating procedures established to ensure that those drugs can be safely stored. It may also require some specific redesign of refrigerators to have separate compartments for non-vaccines. It will certainly require substantial training before the change is made. I think this is a radical policy change that needs to be fully considered before it is adopted. There are clearly advantages to being able to store other products but there may also be avoidable accidents which may, on past experience, be lethal. Anthony
  1. more than a month ago
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  3. # 13
Narayana Holla Accepted Answer
Keeping medicines other than vaccines is not uncommon. During my SMO tenure for more than a decade, several such instances were found but not documented. Newly joined nurse who had not seen multi-dose TT vial administered oxytocin in place of TT to a pregnant woman in one of the 'Taluka' hospitals. When this was shred with AMO of another similar hospital, administration of muscle relaxant came to light. Every specialist rightly has loyalty to their specialization and hence in a multi speciality hospital it is extremely important to share working knowledge in the interest of the lives of beneficiaries. Some of the photos which are preserved for trg purpose are shared. Rabipur was kept in the bottom of the ILR without ice-lining and are likely to freeze. Insulin was also found in the bottom basket, if freezes it may undergo structural change - loosing potency. Lab reagents were also found. (Hands-on trg given during the visit for spot corrections) Hope this may be of some use. http://www.technet-21.org/images/agorapro/attachments/3417/mini_Insulin-in-the-ILR.JPG http://www.technet-21.org/images/agorapro/attachments/3417/mini_Insulin-in-the-ILR.JPG http://www.technet-21.org/images/agorapro/attachments/3417/mini_ARV-in-the-ILR.JPG http://www.technet-21.org/images/agorapro/attachments/3417/mini_Junk-items-in-the-ILR.JPG http://www.technet-21.org/images/agorapro/attachments/3417/mini_Vials-with-Discard-stage-VVM-in-the-same-carton.JPG
  1. more than a month ago
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Michel Zaffran Accepted Answer
I personally agree that we must find ways for life-saving products like oxytocin to be safely kept in the vaccine cold chain. It does not make any public health sense nor is it ethical to "forbid" such a practice on the assumption that health workers would mix up the products, leading to an unsafe practice! Ministries of health should decide how their assets are best used for public health purposes and the vaccine cold chain is one of the most powerful and effective ones of these assets. With adequate training, proper markings, and adequate boxes to segregate products, other essential heat-sensitive products can be stored there; this should be encouraged with appropriate guidance. It is is not reasonable and against all development principles to believe that health workers cannot understand the importance of carefully checking the products they mix or they inject. Terrible programmatic errors have happened in the past with measles vaccine being kept overnight or lyophilized vaccines mixed with insulin or muscle relaxants. These must at all costs be avoided of course, but they are extremely rare events, compared to the millions of safe vaccinations performed every year. EPI can no longer operate its supply and cold chain in isolation from the rest of the public health interventions. Michel Zaffran
  1. more than a month ago
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  3. # 15
mpacque Accepted Answer
There seems to be little information published on what would happen if oxytocin would be inadvertently administrated to infants or newborns. A colleague dug up the following: Hoff DS, Maynard RC. Accidental administration of oxytocin to a premature infant. Neonatal Netw. 2002 Feb;21(1):27-9. Oxytocin has been used for several decades in close proximity to newborns, yet no published information is available regarding complications associated with its accidental administration to a newborn. We describe a case where oxytocin instead of vitamin K was accidentally administered intramuscularly to a premature infant shortly after birth. The patient described remained hemodynamically stable but developed transient hyponatremia as the sole biochemical abnormality. This illustrates that health workers in general seem to be well capable of identifying oxytocin and that if oxytocin would be used to dilute the BCG vaccine, a very smal dose (0.05ml) would be injected with little consequences to the newborn. I would love more comments or experiences
  1. more than a month ago
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mpacque Accepted Answer
Anthony this is a legitimate concern. It appears however that I can't access the pictures you mentioned. Could you share them with me (mpacque@path.org) thank you in advance Michel
  1. more than a month ago
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TechNet Admin Accepted Answer
Admin
Keeping oxytocin in the same refrigerator as vaccines is extremely dangerous and against good practice. I recently saw oxytocin stored in a RCW42 EG, the picture (Pict0017 BCG dil and oxytocin.jpg attached) shows how similar it is to BCG diluent (BCG is on the left). Using oxytocin to reconstitute BCG would probably kill the child. Vaccine refrigerators should only contain vaccine. http://technet-21.org/images/agorapro/attachments/3194/mini_Pict0015-Refr-with-oxytocin.jpg http://technet-21.org/images/agorapro/attachments/3194/mini_Pict0017-BCG-dil-and-oxytocin.jpg
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