title: Have purpose-built vaccine refrigerators reduced the cost of vaccine losses in South Australia?
abstract: OBJECTIVE
  There is limited epidemiological data on the performance of different refrigerator types for vaccine storage in the real world. This study aims to measure if the introduction of purpose-built vaccine refrigerators has reduced the cost of vaccine losses in South Australia.
  
  
  METHODS
  Data were taken from a register for all recorded vaccine storage cold chain events in South Australia from 2008 to 2009 and a survey of vaccine providers conducted in 2009.
  
  
  RESULTS
  There were 531 respondents to the survey (51% response rate). A greater proportion of cold chain breaches in purpose-built vaccine refrigerators did not lead to a loss of vaccine (10.3%) compared with the other refrigerator types. Purpose-built vaccine refrigerators had a relative risk of 3.31 (95% CI, 2.15-5.11) of a heat event (as opposed to cold event) and were more likely to have a cold chain breach from electrical failure (relative risk ratio 15.05, 95% CI 4.04-56.05) than bar refrigerators. The average cost of loss of vaccine for purpose-built vaccine refrigerators was $2,321.20, which was greater than the cost of vaccine loss from a bar refrigerator of $1,339.06 (95% CI $61.47-1,902.82).
  
  
  CONCLUSIONS
  Although purpose-built vaccine refrigerators were less likely to lead to vaccine loss per cold chain breach, they had a greater average cost of vaccine loss per cold chain event because they held a greater volume of vaccine. There is a need for development of Standards to guide purpose-built vaccine refrigerators manufacturing and a review of the National Vaccine Storage Guidelines to place a greater emphasis on the need for back up plans in the event of electrical failure.
authors.affiliation: Communicable Disease Control Branch, SA Health, South Australia.
authors.forename: Katina
authors.initials: K
authors.lastname: D'Onise
authors.forename: Sara
authors.initials: S
authors.lastname: Almond
authors.forename: Breda
authors.initials: B
authors.lastname: MacDonald
authors.forename: Maureen
authors.initials: M
authors.lastname: Watson
authors.forename: Sophie
authors.initials: S
authors.lastname: Scrimgeour
mesh_terms: D004356:Drug Storage / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D011786:Quality Control; D012034:Refrigeration / Q000191:economics / Q000379:methods*; D013021:South Australia; D014612:Vaccines / Q000191:economics*
chemical_list: D014612:Vaccines