Visual inspection of vaccine storage conditions in general practices: A study of 75 vaccine refrigerators

INTRODUCTION: Adequate vaccine storage is a prerequisite to assure vaccine effectiveness and tolerability. In this context, maintaining the cold chain (2°C to 8°C) is the paramount objective. To establish quality-ensured cold chain maintenance, compliance with several structural and procedural aspects is necessary. MAIN OBJECTIVE: The aim of this publication is to assess the quality of vaccine refrigerator management in general practices. METHODS: This study describes baseline results of an intervention study. To evaluate the quality of vaccine refrigerator management, visual inspections were conducted of refrigerators used to store vaccines in general practices of a German teaching practice network. The study instrument was a checklist with ten quality criteria based on international best practices for vaccine storage. A data logger recorded refrigerator temperatures for 7 days. We analyzed associations between reaching more than half (6+) of the ten quality criteria and temperature data. RESULTS: The study included 64 of 168 practices (38.1% response rate) with 75 refrigerators. No practice fulfilled all 10 quality criteria. On average, 4.7 (standard deviation = 1.9) criteria were met. The most frequent deficits were: no drawers/bins/baskets for vaccines (81.3%), no temperature logbook near refrigerator (75.0%), no temperature recording device in the center of the refrigerator (54.0%), vaccines boxes with contact to outer walls (46.3%), and refrigerator unsuitable for vaccine storage (44.6%). Refrigerators with better management (≥6 quality criteria) were more likely to have temperatures in the target range (62.5% vs. 27.5%, p = 0.008). CONCLUSION: We identified a large number of avoidable vaccine storage errors. Effective strategies, e.g. web-based programs, to improve vaccine storage conditions in general practices are needed.