Haworth E A, Booy R, Stirzaker L, Wilkes S, Battersby A
West Berkshire Health Authority, Prospect Park Hospital, Reading.
BMJ. 1993 Jul 24;307(6898):242-4. doi: 10.1136/bmj.307.6898.242.
To investigate the cold chain for vaccines and compliance with the local code of practice for storage.
In a random sample of general practices orders for live vaccines (oral polio and measles, mumps, and rubella) were accompanied by a cold chain monitor which was activated on leaving the supplying pharmacy. The monitors were read at specified intervals and when all vaccines in the order had been used. Structured interview was used to check compliance with the local code of practice on storage.
West Berkshire and Aylesbury Vale district health authorities.
16 (25%) general practices in West Berkshire, and 13 (50%) in Aylesbury Vale.
Compliance with code of practice. Changes in the cold chain monitor.
For six key requirements within the code of practice compliance varied from 70% to 0%. Only 16 of 29 practices had a named person responsible for vaccine storage and only four were aware of the local code of practice. Vaccine was stored for longer and more breaks in the cold chain occurred in West Berkshire than in Aylesbury Vale. The potency of some vaccines in 10 of 26 orders became suspect before use.
Knowledge of appropriate management of the cold chain in two districts was poor. Breaks in the chain were more frequent and compromised potency more likely when vaccine had been stored for more than eight weeks. Problems in maintaining the cold chain indicate the need for continuing audit, which should become a prerequisite for payments to general practitioners for immunisation.
调查疫苗冷链情况以及是否符合当地储存操作规范。
在随机抽取的普通诊所样本中，订购的活疫苗（口服脊髓灰质炎疫苗以及麻疹、腮腺炎和风疹疫苗）均配备了一个冷链监测器，该监测器在离开供应药房时启动。在规定的时间间隔以及订单中的所有疫苗都已使用时读取监测器数据。采用结构化访谈来检查是否符合当地储存操作规范。
西伯克郡和艾尔斯伯里谷地区卫生当局。
西伯克郡的16家（25%）普通诊所，以及艾尔斯伯里谷的13家（50%）普通诊所。
符合操作规范情况。冷链监测器的变化情况。
对于操作规范中的六项关键要求，符合率从70%到0%不等。29家诊所中只有16家有指定人员负责疫苗储存，只有4家知晓当地操作规范。与艾尔斯伯里谷相比，西伯克郡疫苗储存时间更长，冷链中断情况更多。26份订单中有10份订单中的部分疫苗在使用前效力存疑。
两个地区对冷链适当管理的了解较差。当疫苗储存超过八周时，冷链中断更频繁，效力受损的可能性更大。维持冷链存在的问题表明需要持续进行审核，这应成为向全科医生支付免疫接种费用的先决条件。
