RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA -560078
ANNEXURE-II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTION
1 / NAME OF THECANDIDATE AND ADDRESS / Mr. VENKATESHAPPA
ISTYEAR.M.SC. NURSING
RATHNA COLLEGE OF NURSING
HASSAN
KARNATAKA-573201.
2 / NAME OF THE INSTITUTION / RATHNA COLLEGE OF NURSING
K.R.PURUM. HASSAN.
3 / COURSE OF THE STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
COMMUNITY HEALTH NURSING.
4 / DATE OF ADMISSION TO COURSE / 05-07-2010
5 / TITLE OF THE TOPIC / EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON COLD CHAIN MAINTENANCE AMONG JUNIOR HEALTH ASSISTANT FEMALE STUDENTS.
5.1 / STATEMENT OF THE PROBLEM / A STUDY TO ASSES THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON COLD CHAIN MAINTENANCE AMONG JUNIOR HEALTH ASSISTANT FEMALE STUDENTS IN SELECTED TRAINING CENTERS AT HASSAN.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Education as manifestation of perfection already in man “
Swami Vivekananda
Vaccine is an immune-biological- substance designed to produce specific protection against a given disease. It stimulates the production of protective antibody and other immune mechanisms. “Cold chain maintenance” is the system of storage and transport of vaccines at a low temperature from the manufacturer to the actual vaccine site. In general all vaccines must be stored under the conditions recommended by the manufacturer in the literature accompanying the vaccines otherwise they become denatured and totally ineffective.
Cold chain maintenance is necessary because vaccines failure may occur due to failure to store and transport under strict temperature control. This is of concern in view of the fairly frequent reports of vaccine preventable disease occurrence in population thought to have well immunized. Among the vaccine polio is the most sensitive to heat, requiring storage at minus 2 degree centigrade .Vaccines which must be stored in the freezer comportment are polio and measles. Vaccines which must be stored in the cold part but never allowed to freeze are Typhoid, Diphtheria, Pertusis, Tetanus Toxoids, BCG and diluents.1
The cold chain in other words the manufacturing company and storing the vaccines at a temperature suggested by it, right from manufacture of the vaccine to the health workers at grass route level contribute significantly in cold chain of vaccines. The term C4- complete care cold chain is also in vague in the maintenance of cold.2
Cold chain for vaccine is a system for storing transporting vaccines at a very low temperature to maintain their effectiveness before use, because vaccines are sensitive to biological, substances their exposition to high temperature directly affect the quality of vaccines and safety of immunization. The goal of the study was to asses the safety of cold chain system.3
Child immunization is among the most cost effective ways of preventing premature deaths and the potency of vaccines crucial for vaccines efficacy it is dependent on effective management of cold chain at all levels of vaccines handling. 4
The storage and transport of vaccines at appropriate temperature is vital to vaccine safety and efficacy. Attention has traditionally focused on heat exposure of vaccines, but studies have indicated that exposure of vaccines to freezing temperatures may be more common. Freeze- sensitive vaccine like DTP-HB can lose their potency when exposed to freezing temperatures as a result of dissociation of the antigen protein from the alum adjuvent.5
If we properly maintain the recommended temperature while carrying vaccine, storing vaccine till it is used, 100% we can protect the peoples from occurring major communicable diseases.
6.1. NEED FOR THE STUDY
The vaccines play a major role in preventing mainly major communicable diseases which the people die because of these communicable diseases. It is necessary to provide vaccines against these diseases but the maintenance of the vaccine potentiality is most important because if we give non potentiality vaccines will not protect people from killer diseases in order to maintain potentiality of vaccines the maintenance of the cold chain system is necessary
Cold chain system is necessary because the vaccines are sensitive to heat, if the vaccines are exposed to heat they will have shortened life. Some vaccines are more sensitive than others. Polio is the most sensitive to heat. When the vaccines lose their potency they can no longer protect individuals from diseases. Vaccines potency cannot be regained once it is lost. Returning vaccines to the refrigerators will not restore its potency, all vaccines retain their potency at temperature between 2- 8 C, so the vaccines must stay cold or maintain optimum temperature to the actual vaccination site of expectant mother and child all the way from manufacture storage and transportation.6
In India 15% to 30% cases of poliomyelitis occur in children who have received primary immunization with the oral polio vaccine. A study conducted on knowledge, attitude and practice of cold chain maintenance in immunization. Selected 324 MBBS students, 138 Interns, and 105 non pediatrics residents at Ahmadabad. Amongst these subjects 15%, 10%, and 12% respectively did not know why the vaccine need cold chain and 23%, 22%, and 25% respectively did not know who to carry vaccine in the field. Out of 324 MBBS students 4, 1.2% had correct knowledge and 22, 6.8% had knowledge of storage of only 2 vaccines. Out of 132 Interns 7, 5.3% had correct knowledge and 17, 12.9% had knowledge of storage of more than 2 vaccines and out of 105 non pediatric residents none 0% had knowledge of storage of vaccines only 9, 8.6% had knowledge of storage of more than 2 vaccines.7
All the steps are very important but the maintenance of the cold chain is especially important for the success of the immunization programme.8 Maintenance of the vaccine cold chain is integral to administering potent vaccines thereby protecting individuals and communities against vaccine preventable disease. Previous studies have highlighted threats to vaccine cold chain integrity. In New South Wales of Australia, a study conducted on practices nurses best protect the vaccine cold chain in general practice and found 98% of general practices where a general practice nurse was employed maintained cold chain integrity ,whereas only 42% of general practices where no general practice nurse was employed.9
The cold chain refers to the people, equipments, and procedure designed to maintain appropriate temperature for vaccines from the time they leave the manufacture through transportation and storage until the point of use linked with information about dispatch time and reaching time of vaccines, health workers are responsible to maintain the temperature of vaccines at peripheral level. If vaccines are exposed to too much heat, cold, it can be damaged and lose its potency. If that happens all the effort to give the vaccines to the child is lost.10
Creating awareness among people those carrying these vaccines about the importance of cold chain maintenance is very much essential for health workers, transportation workers, vaccine storage workers, and also medical students, nursing students, junior health assistant female students those who works with vaccine in community. Health education is the important component of the strategy to reach goal of Health for all in 21st century. Health education is given through varies means like structured teaching programme, video assisted teaching programme, planned teaching programme, electronic media etc. Structured teaching programme is an effective means of importing education.
There are many studies that support the need of teaching programme regarding cold chain maintenance for health workers. Keeping the above facts and having 16 years personal and professional experience the student investigator plan to conduct a study on “cold chain maintenance” among Junior Health Assistant Female Students in selected Training Centers at Hassan.
6.2 REVIEW OF LITERATURE
Review of literature is the selection of available documents on the topic which contain the information, ideas, data and evidences. It is an examination of the research that has been conducted in a particular field of study.
The literature reviewed under the following heading
Part 1: Reviews related to immunization service and the problems due to improper
Immunization
Part 2: Studies related to knowledge of health workers regarding cold chain maintenance
Part 3: Studies related to educational programme on cold chain maintenance
Part 1: Reviews related to immunization service and the problems due to improper
Immunization
A study was done to investigate the cold chain for vaccine and compliance with the local code of practices for storage. Random samples of general practices were accompanied by a cold chain monitor. The monitors were read at specified intervals which were used. 16, 25%general practices in West Berkshire and 13, 50% in Aylesbury Vale were selected. Structured interview was used. Compliance with code of practice varied from 70% to 0%, only 16 to 29 practices had named persons responsible for vaccine storage and only 4 were aware of the local code of practices, vaccine was stored for longer and more breaks in chain occurred in West Berkshire than in Aylesbury Vale. The potency of same vaccine 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 cold chain were frequent, problems in maintaining the cold chain indicate the need for continuing audit.11
A survey conducted to asses the methods of vaccines transportation and storage of 52 primary vaccination offices inspected, 39, 76.5% had a refrigerator for vaccine storage but only 17, 33.3% kept records of received and stored doses, none of the 7 main offices selected for monitoring had a maximum and minimum thermometer and none monitored the internal temperature of the refrigerator, more over other faulty procedure such as storage of food, and laboratory specimens in the refrigerators door shelves, indicated that the knowledge and practices of the vaccines storage and handling were often inadeqwuate.12
A study conducted to evaluate the cold chain system in two district of Haryana as there were frequent breakdowns of ice lined refrigerators during the previous year. The study reveals that defective stabilizers and electricity plugs and sockets were the reason of breakdown in many cases. Retrospective analysis showed that the polio vaccine samples picked up during early years were found to be satisfactory by CRI. Kasauli.Use of two ice-pick carrier and thermos flasks was associated with poor temperature maintenance. There were 7vaccine carriers out of 25 examined had cracked wall lining. Lids of carriers were also not kept tight during vaccination sessions. Response log of the health workers and medical officers in case of breakdowns was delayed. A one day refresher course exclusively on cold chain maintenance at community health centre level is recommended.13
A study conducted on evaluation of cold chain system for vaccine with objectives to know the training status of the personnel, refrigeration facilities, storage, monitoring, and potency of vaccines. It was observed that 6.6% of general practioners were trained under universal immunization programme. Monitoring was not satisfactory and two of the oral polio vaccine samples from medical practitioners’ had an unsatisfactory titer dose, comprehensive orientations/training on cold chain is essential for medical practitioners and other health professionals.14
Part 2: Studies related to knowledge of health workers regarding cold chain
maintenance
A cross sectional study was conducted with the objectives of ascertaining how the cold chain kept intact as well as determining heat stability is concerned. A study conducted in 46 primary care vaccination points, the data was gathered by means of a personal interview by one single researcher; only 3 were participated out of 46. An unsuitable temperature was found in three cases 6.97% the percentage of professionals who were aware of the effect freezing has an vaccine varied greatly 53.5%, 51.2%, 44.2%, and 53.5%, for Diphtheria-Tetanus-Pertusis, Hepatitis B, Oral Polio and Measles-Mumps- Rubella respectively and only 32% were familiar with the shake test. The professionals were found to be properly trained regarding the effect which high temperature has vaccines, but it is necessary for their training with regards to the instability of adsorbed preparations when frozen must be further strengthened.15
A study conducted on awareness about the vaccine vial monitor at pulse polio booths. All members present on booth working on national immunization day. Interview made by using predesigned and pre tested questionnaire to asses their awareness regarding type of oral polio vaccine vial monitor in urban areas, identification of trivalent OPV was highest 54.8% among health staff members working at booths, but for monovalent OPV it was poor 38.7 more than half 50% of the staff members interviewed had not heard of vaccine vial monitor. Awareness was very poor for VVM among those who heard regarding its function how to read VVM and when OPV should be discarded.16
A descriptive study was conducted with objectives to know about cold chain. About 340 midwives participated working in 35 Primary Health Care Unites. Nearly 80 of the midwives who worked for 10 years or less,109 for 11-15 years and 151 for 16 years or more. Most who had worked for 11-15 years and for 10 years or less were aware of the need to keep vaccines in a refrigerator between 2-8 degree centigrade but 63 of midwives who had worked for 16 years or more did not know the length of time vaccines that had never been used could be stored under primary health care center condition. Most midwives had adequate knowledge of cold chain, however with continuing education knowledge can be corrected and awareness of their roles and responsibilities can be increased to achieve goal of immunization.17
A study conducted with objectives of highlighting the awareness of pulse polio center staff about polio vaccine vial monitor during a national immunization day. Out of 79 staff members interviewed only 53, 67% had ever heard of the vaccine vial monitor and were further interviewed, 50, 94.45% staff members were aware that vaccine vial monitor is present on vaccine itself and majority 79.2% total that is the inner square with out circle only half were aware of its function and 71.7% new how to read it. It was observed that awareness among health workers particularly female auxiliary midwife and volunteers was very poor. There is need for effective training of staff before subsequent pulse polio immunization to maintain an effective cold chain.18
Part 3; Studies related to educational programme on cold chain maintenance
A crass sectional study was conducted to evaluate the cold chain in the vaccination point of health deportments including training of staff responsible for the cold chain. A structured questionnaire was used to gather information on characteristics of vaccine center, the staffs responsible for cold chain and knowledge of staff. The temperature were mostly in the correctly located, at least one staff member was responsible for the vaccine in all the centers but food was found in the refrigerators, vaccines were conserved on the vaccination label, on the day of vaccination the temperature chart was not recorded daily in 75%. However the vaccine infrastructure in primary care center as well as training of the staff responsible for the cold chain should be improved.19