In Bhutan, opened vaccine in Out Reach Clinic (ORC) and leftover vaccines are discarded at the end of the session as we do not have the open vial policy. Only unopened vaccines are brought back and are used in the subsequent immunization session that are also maintained in proper cold chain. But what if we bring back the opened leftover liquid vaccine from the ORC and use it for the next session? What is Technet group members' opinion/view on it?
Hi Tshewang:
Multi-dose vial policy is when one or more doses of vaccines have been removed from a vial during an immunization session and this vial may be used in subsequent immunization sessions for up to 4 weeks provided that the follow conditions are met:
- The expiry date has not passed
- The vaccines are stored under appropriate cold chain conditions
- The vaccine vials septum has not been submerged in water
- Aseptic technique has been used to withdraw all doses
- The vaccine vial monitor (VVM) has not reached the discard point
In most cases, open vials from out reaches will get contaminated ( septum getting in touch with icepacks) due to movement of vials in the vaccine carrier hence breaking one of the MDVP rules. And for this reason, most people prefer disposing off these open vials from the outreaches as they are not sure of their status and we currently have no machine to sense this.
The expiry date has not passed.
The vaccines are stored under appropriate cold chain conditions both during
transportation and storage in cold chain storage point.
The vaccine vial septum has not been submerged in water or contaminated in any
way.
Aseptic technique has been used to withdraw vaccine doses. (That is needle/septum
has not been contaminated in anyway)
The vaccine vial monitor (VVM), has not reached/crossed the discard point.
Discard vaccine vial in case any one of the following conditions is met:
Expiry date has passed.
VVM reached/crossed discard point (for freeze dried vaccine, before reconstitution
only) or vaccine vials without VVM or disfigured VVM.
No label/partially torn label and/or writing on label not legible.
Any vial thought to be exposed to non-sterile procedure for withdrawal.
Open vials that have been under water or vials removed from a vaccine carrier that
has water.
If vaccine vial is frozen or contains floccules or any foreign body.
If there is breakage in the continuity of the vials (crack/leaks).
If there is any reported AEFI following use of any of the vaccine vial, do not use it,
and retain it safely. Inform Medical Officer and/or Supervisor.
2)
Health workers must be able to distinguish between vials that can be used in subsequent sessions and vials that must be discarded. Training and supervision materials should be revised to reflect the policy change.
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