Effectiveness of a web-based education program to improve vaccine storage conditions in primary care (Keep Cool): study protocol for a randomized controlled trial

Abstract

BackgroundImmunization programs are among the most effective public health strategies worldwide. Adequate vaccine storage is a prerequisite to assure the vaccines’ effectiveness and safety. In a questionnaire survey among a random sample of German primary care physicians, we discovered vaccine storage deficits: 16 % of physicians had experience with cold chain breaches either as an error or near error, 49 % did not keep a temperature log, and 21 % did not use a separate refrigerator for vaccine storage. In a recent feasibility study of 21 practice refrigerators, we showed that these were outside the target range 10.2 % of the total time with some single refrigerators being outside the target range as much as 66.3 % of the time. These cooling-chain deficits are consistent with the international medical literature, yet an effective, easy to disseminate, practice-centered intervention to improve storage conditions is lacking.Methods/designThis randomized intervention trial will be conducted in a random sample of primary care practices. Based on continuous temperature recordings over 7 days, all practices with readings outside the target range for vaccine storage (+2 °C to +8 °C) will be randomly allocated to a web-based education program or a waiting list control group. The practice physicians and their teams constitute the target population. Participants will be educated about best practices in vaccine storage and will receive a manual including storage checklists and templates for temperature documentation. In all practices, temperatures of the vaccine refrigerators will be monitored continuously using a data logger with a glycol probe as a surrogate for vaccine vial temperature. The effectiveness of the web-based education program will be determined after 6 months in terms of the proportion of refrigerators with vaccine vial temperatures within the target range (+2 °C to +8 °C) during 7-day temperature logging. Secondary outcome parameters include temperature monitoring, no critically low temperatures (≤ -0.5 °C), compliance with storage recommendations, knowledge of good vaccine storage conditions, and assignment of personnel as vaccine storage manager and backup.DiscussionKeep Cool will develop and evaluate a web-based education program to improve vaccine storage conditions in primary care and thereby ensure immunization safety and effectiveness.Trial registrationDRKS00006561 (date of registration: 20 February 2015)

Collective construction of bundle for immunobiological agents conservation best practices

“…At the monitoring of refrigeration equipment temperature, thermometers of maximum and minimum digital are usually used. However, their use is not considered best practice and, according to current recommendations, their substitution by electronic temperature recorders (5,(20)(21) .…”

“…Thus, in order for the diseases to be controlled or eradicated, it is necessary to guarantee vaccines efficacy by means of strict attention to cold chain maintenance of immunobiological agents conservation; from national to local spheres, where vaccines are administered to people (3) . Considering the cold chain process relevance, research has been carried out in order to follow up and evaluate this process, but it was pointed out the need for training of the professionals working at vaccination room at Primary Health Care Units (PHCU) (4)(5)(6) , as well as the elaboration and implementation of protocols at the local level within the cold network (7) .…”

Eventos críticos na manutenção da conservação de vacinas

“…1,24 Most vaccination rooms do not yet have this equipment available. 18,22,25 Such a situation may compromise the safety of immunobiological conservation since the household refrigerator does not maintain a homogeneity in temperatures and does not prevent the freezing of vaccines. [4][5] In addition, in Brazil, Cameroon, India, New Zealand and Ethiopia, irregularities were detected in the storage, cleaning and operation of domestic refrigerators.…”

“…The World Health Organization's new performance, quality and safety specifications bring clarity to the issue and recommend the use of only cold water packs for vaccines sensitive to freezing. 22 Another solution would be the production of thermostable vaccines reducing dependence on the cold chain and impacting the stability and potency of vaccines. 21,24,32 Not only during transport, but also during the storage of vaccines, it is necessary to strictly monitor temperatures with measuring equipment such as thermometers.…”

How often people google for vaccination: Qualitative and quantitative insights from a systematic search of the web-based activities using Google Trends

“…These aids appear to be effective and also cost-effective. 31 The Internet can be exploited also for promoting vaccination-related advocacy 32 and for increasing education among health-care workers, 33 especially in low-and middle-income countries (LMICs). 34 In an investigation performed in Melbourne, Australia, the Internet proved to be an effective mean for increasing participation and coverage rate during the influenza vaccination campaign.…”