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Strive For Five’s most dangerous mistake

I have mixed emotions when it comes to Strive For Five. Originally it was a great document that helped move us out of the dark ages and eventually saw bar fridges banned in pharmacies and GPs. It provided helpful tips on how to effectively store vaccines, and was a great starting point for best practice.

Then the second and now the third editions are out and it appears that the writers are floundering to come to terms with changing technology. Section 4.6 wipes it hands totally when it comes to how automated temperature-monitoring systems are used.

This post, however, I want to focus on what I see is the most frightening concept that has crept into Strive For Five and why it is such a bad idea if it is allowed to stay and be supported.

Temperature loggers should NOT be built into vaccine fridges

All through Strive For Five are feature lists as to why vaccine fridges are so good. For example, in section 3.1 it says:

inbuilt digital temperature monitoring (inbuild data logger) and/or digital temperature indicators (minimum and maximum temperature displays)

To understand why this is such a bad idea, you need to understand what is going on and what the intent is.

How fridge controllers work

One of the great features of a vaccine fridge (and many modern domestic fridges) is that they have a computer to control the fridge. They work by having a sensor that monitors the temperature, and then they turn the compressor on or off. This, in turn, cools the fridge down. 

This is much better than old domestic fridges where the controller simply turned on at a certain temperature (based on that meaningless dial) and then turned off a fixed time later. With a modern controller both the on and off temperatures are controlled. 

The next beneficial feature that a vaccine fridge has is the display of the temperature. Once again a good thing.

For example, if the compressor were to stop:

The temperature would now be uncontrolled and the fridge would become too hot. 

The display would show the high temperature and the staff would be aware of the problem. 

Vaccine fridges also have the benefit of connecting to an audible alarm, and external relays. These are all good features to help warn staff if there is a problem with the fridge…

… mostly.

If the sensor starts to drift it will be reporting the wrong temperature to the controller. The controller will continue to control the fridge but based on the wrong data. The temperature in the fridge will move in the opposite direction to compensate. For example, if the sensor was reading 2° too high, the fridge would drop by 2°.

The display would be showing the adjusted temperature. It is totally unaware that there is a problem.

If this temperature was used for the twice daily check, the staff would be totally unaware that there is a problem.

The solution is easy - "independence"

Now there is a sensor that is totally independent of the fridge controller. 

If the sensor is faulty the thermometer will detect it.

And now to show why Strive For Five got it wrong

By allowing the user to have a vaccine fridge with an inbuilt logger, it is now possible to have the wrong temperature not only being used to control the fridge, but be displayed to the user and be logged. 

This totally defeats Strive For Fives requirement of having two monitoring devices.

The solution is easy – the temperature logger must be totally independent of the controller and its sensor.

This makes it worse

Up until now I have talked about “the temperature of the fridge”. The problem is, the temperature is the fridge is not constant. In reality there are warmer and cooler spots. Many vaccine fridges will measure the return air temperature and control it. Most of the time that is fine.

If, however, the vaccine fridge is over stocked then the temperature variation becomes even larger. Wind tunnels form and it is possible to have very cold spots.

If the fridge opens regularly then warms spots are more likely at the front of the fridge.

The solution is still easy - "independence"

The temperature logger needs to be able to be placed ANYWHERE within the fridge. It needs to be able to be placed where vaccines are kept.

We have seen vaccine fridges where they have third party built-in loggers and they deliberately place the logger sensor next to the fridge sensor. This ensures that the variation between the displayed temperature and the logged temperature are minimised. It looks great, but is just false optimism.

The temperature logger needs to be mobile within the fridge. It can’t be locked in by the manufacturer. 

But what about YOU

This post is about saying why allowing the concept of a built-in logger is a bad idea. Strive For Five hasn’t mandated it. You are free to use temperature loggers that are totally independent of the vaccine fridge. 

Avoid built-in loggers. They are designed to make the vaccine fridge look good.

“Be happy” when you see a variation between the fridge display and the logger. They are independent and are reporting different locations.

Don’t be happy if either of them are out of the 2° to 8° range. It means that something is wrong. 

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The National Association of Testing Authorities (NATA) is the recognised national accreditation authority for analytical laboratories and testing service providers in Australia. It is an independent, not-for-profit organisation that provides independent assurance of technical competence. 

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