Exploring Challenges to COVID-19 Vaccination in the Darfur Region of Sudan.

The current COVID-19 pandemic has affected the ability of health systems to provide essential services globally. The Darfur region, located in the western part of Sudan, has been largely devastated by the war that began in 2003 and has been drawing considerable attention from the international community. The war, which erupted as a result of environmental, political, and economic factors, has led to tragic outcomes. Collapsing health-care infrastructures, health workforce shortages, lack of storage facilities for medicines and medical products, and inadequate access to health services are some of the effects of the war. After Sudan received the AstraZeneca COVID-19 vaccine through the COVID-19 Vaccines Global Access facility, significant challenges have been implicated in the delivery, storage, and use of the vaccine in the Darfur region. Lack of vaccine storage and transportation facilities, vaccination hesitancy, inequity in the distribution to health facilities, and shortage of health-care professionals resulting from insecurity and instability have added an extra layer of burden on local authorities and their ability to manage COVID-19 vaccinations in the region adequately. Addressing the impact of COVID-19 requires an effectively managed vaccination program. In the face of current challenges in Darfur, ensuring a fully vaccinated population might remain far-fetched and improbable if meaningful efforts are not put in place by all stakeholders and actors to address some of the challenges identified.

Controle de temperatura de refrigeradores / Control de la temperatura de los refrigeradores / Refrigerator temperature control

Esta Norma Técnica tem por objetivo estabelecer as orientações necessárias para o controle de temperatura das geladeiras em Bancos de Leite Humano e Postos de Coleta de Leite Humano, visando a garantia da qualidade nestes serviços e sua certificação.

Esta Norma Técnica tiene como objetivo establecer las orientaciones necesarias para el control de la temperatura de los refrigeradores en los Bancos de Leche Humana y en los Centros de Recolección de Leche Humana, con el fin de asegurar la calidad de estos servicios y su certificación.

Knowledge, attitude and practice of vaccinators and vaccine handlers on vaccine cold chain management in public health facilities, Ethiopia: Cross-sectional study.

BACKGROUND: Effective management of the vaccine cold chain system at all levels is one of the crucial factors for maintaining vaccine potency. Vaccines require more complex handling and storage requirements due to increased temperature sensitivity and complicated immunization schedules. This urges adequate knowledge, attitude, and practice. This study assessed the knowledge, attitude, and practice of vaccinators and vaccine handlers' in public health facilities. METHODOLOGY: An institutional-based cross-sectional study design was used to assess the knowledge, attitude, and practice of 127 vaccinators and vaccine handlers in public health facilities of Oromia Special Zone, from September 1 to 30, 2019. Data were collected using self-administered questionnaires and a structured observation checklist. Descriptive and inferential statistics were made using the statistical package for social sciences version 20. Variables with a p-value <0.05 were taken as statistically significant. RESULT: The response rate was (96.94%). Sixty-eight (53.5%; 95% CI: 46.5%, 61.4%), 58 (45.7%; 95% CI: 37.8%, 53.5%) and 62 (48.8%: 95% CI; 41.7%, 56.7%) vaccinators and vaccine handlers had satisfactory knowledge, positive attitude and good practice respectively. Receiving training on cold chain management had a statistically significant association with the level of knowledge on cold chain management (AOR = 3.04, 95% CI: 1.04-8.88). CONCLUSIONS: More than half of vaccinators and vaccine handlers had satisfactory knowledge, while below half of vaccinators and vaccine handlers had a positive attitude and good practice. The determinants of knowledge in cold chain management were receiving training on cold chain management. Providing regular technical support and on the job training on vaccine cold chain management will improve the knowledge, attitude, and practice of vaccinators and vaccine handlers.

Grand Challenges in Pharmaceutical Research Series: Ridding the Cold Chain for Biologics.

Biologics are complex pharmaceuticals that include formulated proteins, plasma products, vaccines, cell and gene therapy products, and biological tissues. These products are fragile and typically require cold chain for their delivery and storage. Delivering biologics, while maintaining the cold chain, whether standard (2°C to 8°C) or deepfreeze (as cold as -70°C), requires extensive infrastructure that is expensive to build and maintain. This poses a huge challenge to equitable healthcare delivery, especially during a global pandemic. Even when the infrastructure is in place, breaches of the cold chain are common. Such breaches may damage the product, making therapeutics and vaccines ineffective or even harmful. Rather than strengthening the cold chain through building more infrastructure and imposing more stringent guidelines, we suggest that money and effort are best spent on making the cold chain unnecessary for biologics delivery and storage. To meet this grand challenge in pharmaceutical research, we highlight areas where innovations are needed in the design, formulation and biomanufacturing of biologics, including point-of-care manufacturing and inspection. These technological innovations would rely on fundamental advances in our understanding of biomolecules and cells.

Home storage of biological medications administered to patients with rheumatic diseases.

BACKGROUND: The inadequate storage of biopharmaceuticals may result in an ineffective therapeutic response since poor conservation can lead to the emergence of protein aggregates and cause immunogenicity in patients, which can increase the risk of adverse events by inducing the production of anti-drug antibodies. This can also lead to significant economic losses for public health, given the high cost of these medicines. The aim of this study was to verify whether the home storage of biopharmaceuticals dispensed by the Unified Public System was in accordance with the manufacturers' specified standards and whether external variables interfered with the correct home storage. METHODS: This was a prospective observational study. Patients with a confirmed diagnosis of rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis who were using a biologic exclusively dispensed by Unified Public System were included. Storage temperature was measured by digital thermometer inserted into the refrigerator of the participant's home. Fisher's exact test was performed to cross-reference the temperature data and the qualitative variables obtained using an epidemiologic questionnaire. Mean, minimum, maximum values and standard deviation were described in the quantitative data. Mann-Whitney non-parametric test was performed to the association between temperature excursion and the number of people in the house. RESULTS: A total of 81 participants were included and 67 (82.71%) did not maintain home storage correctly. The maximum temperature observed among all patients was 15.5 °C, the minimum was - 4.4 °C and the average was 5.6 °C (standard deviation 2.8); 10 (12.3%) had at least one negative temperature measured. The average time for participants who had an inadequate temperature record was 8 h and 31 min. Nine participants (90%) who stored the medication into the shelf/drawer below the freezer had a temperature excursion (p = 0.011). Most of the participants (88.5%) who stored their biopharmaceutical near the back side, close to the wall of the refrigerator had a negative temperature record (p < 0.001). CONCLUSION: Most of the study participants (82.71%) did not maintain adequate home storage conditions for their biopharmaceutical. Intrinsic factors of household refrigerators may be involved in temperature deviations.

Comparative Effects of Carum copticum Essential Oil on Bacterial Growth and Shiga-Toxin Gene Expression of Escherichia coli O157:H7 at Abused Refrigerated Temperatures.

Abused refrigerated temperatures are described as unacceptable deviations from the optimal temperature, occurring frequently during transportation of food products. Escherichia coli O157:H7 is a serious contaminant of meats and meat products due to its ability to grow at abused temperatures (> 10 °C). The aim of this study was to evaluate the antibacterial activity of Carum copticum essential oil for the control of Escherichia coli O157:H7 using laboratory media and minced beef at severe abused refrigerated temperature (15 °C). A comparative quantitative reverse transcription real-time PCR was used to assess effects of temperature and Carum copticum essential oil at sub-minimum inhibitory concentrations on bacterial growth and Shiga-toxin gene (stx1A and stx2A) expression. Results indicated that Carum copticum essential oil inhibited growth of E. coli O157:H7 in tryptone soy broth (TSB) media at all sub-MIC values until Hour 48. However, bacterial population increased progressively until Hour 72 at essential oil concentration of 0.75% (ml g-1) and reached 8.6 log CFU g-1 in minced beef. The essential oil at concentration of 0.005% (ml g-1) increased stx gene expression at all times, but increased stx gene expression (0.015%) at Hour 24 in TSB media. The expression rate of stx1A in minced beef decreased progressively (10.39 and 7.67 folds for 0.5 and 0.75%, respectively) and expression of stx2A was variable in minced beef during storage. In conclusion, results from this study have shown that effects of Carum copticum essential oil on growth and virulence gene expression are not necessarily correlated and temperature, essential oil concentration, investigated gene type, and bacterial growth environment (in vivo or in vitro) are effective as well.

Commercially Available Insulin Products Demonstrate Stability Throughout the Cold Supply Chain Across the U.S.

OBJECTIVE: A recent publication questioned the integrity of insulin purchased from U.S. retail pharmacies. We sought to independently validate the method used, isotope dilution solid-phase extraction (SPE) liquid chromatography mass spectrometry (LC-MS), and expand analysis to two U.S. Pharmacopeia (USP) methods (high-performance LC with ultraviolet detection and LC-MS). RESEARCH DESIGN AND METHODS: Each method was used to evaluate nine insulin formulations, purchased at four pharmacies, within five geographic locations in the U.S. RESULTS: All human and analog insulins measured by the USP methods (n = 174) contained the expected quantity of active insulin (100 ± 5 units/mL). When using isotope dilution SPE-LC-MS, units-per-milliliter values were well below product labeling due to unequal recovery of the internal standard compared with target insulin. CONCLUSIONS: Insulin purchased from U.S. pharmacies is consistent with product labeling.

Effect of sample delivery conditions on Renin-Angiotensin-Aldosterone System (RAAS) assay.

Renin-Angiotensin-Aldosterone System (RAAS) measurements are influenced by several factors. We investigated the effect of sample delivery conditions on RAAS measurements including sample storage temperature and time. Blood samples were collected from thirty participants using enzyme inhibitor tubes and serum separation gel evacuated tubes. Plasma and serum from fresh blood samples without further storage (as baseline), and from blood samples that were stored at either 0 °C, 4 °C, or 25 °C for 3 h, 6 h and 24 h, respectively, were extracted and stored at -30 °C for batch measurements using radioimmunoassay. Concentrations of Aldosterone (Ald) decreased following delivery temperature and time, and were significantly different when samples were set aside at 0 °C for 24 h (p < .01), 4 °C for 6 h (p < .01), and 25 °C for 3 h (p < .05). However, levels of Angiotensin (Ang I) increased following delivery temperature and time, and were significantly different when samples were set aside at 0 °C and 4 °C for 6 h (p < .05) and at 25 °C for 3 h (p < .001). However, no changes were observed for the concentrations of plasma renin activity (PRA) and Ang II, except for Ang II which increased significantly when samples were set aside at 25 °C for 24 h (p < .001). Our results indicate that samples used for RAAS measurement should be placed at a low temperature and analyzed as soon as possible after collection.

Assessment of cold chain equipments and their management in government health facilities in a District of Delhi: A cross-sectional descriptive study.

BACKGROUND: Cold chain equipments (CCEs) at health facilities (HFs) are an essential part of the immunization supply chain (ISC). The CCEs in government HFs of Delhi were never assessed using the World Health Organization-United Nations Children's Fund (WHO-UNICEF) Effective Vaccine Management (EVM) tool except that of state vaccine store during National EVM assessment 2013. OBJECTIVES: The objective of the study was to assess the CCEs and their management in government HFs using the WHO-UNICEF EVM tool in a district of Delhi. METHODS: The assessment was done during December 2017-March 2018 in one randomly selected district of Delhi. Sample size and site selection were done using the WHO EVM site selection tool. A total of 29 HFs were assessed along with District Vaccine Store. Questions on CCEs in EVM tool 1.0.9 were used for data collection. RESULTS: Out of 56 electrical CCEs, 8.9% were nonfunctional, 48.2% were noncompliant with WHO standards, 5.4% were not chlorofluorocarbon free, 4.7% did not have temperature monitoring device, and 18.8% did not have stabilizer. Eighty-six percent of passive containers were compliant with the WHO standards. The storage capacity of electrical vaccine storage equipment was insufficient in 3.4%, passive container capacity in 65.5%, and ice packs preparation and storage capacity in 24.1% of HFs. There was no planned preventive maintenance of CCEs and no standard operating procedures for emergency event management. CONCLUSION: There was a shortage of vaccine storage, ice packs preparation and storage, and passive container capacity. Many CCEs used in ISC of assessed sites were noncompliant to the WHO standards. There was no PPM of CCEs and no guidelines for emergency event management.

A comparative assessment of cold chain management using the outbreak of circulating vaccine-derived polio virus type 2 as a surrogate marker in Oyo State, Nigeria-2019.

INTRODUCTION: inspite of the demonstrable evidence of the preventive and protective ability of vaccines to reduce the outbreak of vaccine-preventable diseases, there are still some significant disease outbreaks recorded in our communities. In some settings, these outbreaks have been linked with poor vaccine management. Therefore, this study was conducted to compare the cold chain practices in Oyo State, Nigeria. METHODS: we conducted a cross-sectional survey among health workers in the local government areas of Oyo State between October and November 2019. Using purposive sampling, we recruited all the 84 routine immunization focal persons for the study. A self-administered questionnaire was used to collect data on cold chain management. Data were analyzed using SPSS version 24 and bivariate analysis was done using Chi-square. Statistical significance was set at p < 0.05. RESULTS: the mean age of the respondents was 46.4 ± 6.7 years. Most prevalent cadre in the rural facilities was health assistants (87.5%) while Community Extension Health Workers (54.8%) were prevalent in the urban (p = 0.002). The proportion of respondents with adequate cold chain equipment was significantly higher in the urban compared with the rural area. The cold boxes were the only adequate cold chain equipment found in the rural health facilities compared with the urban (p = 0.036). CONCLUSION: there was a low proportion of qualified health workers and inadequate cold chain equipment in the rural area compared with the urban facilities. Engagement of skilled health workers and supply of the cold chain equipment are recommended.

Aseguramiento de la calidad de la cadena de frío en la distribución farmacéutica / Cold chain quality assurance in pharmaceutical distribution

INTRODUCCIÓN: Una cadena de frío de calidad es aquella en la que se aseguran de manera integral todos los elementos necesarios para su adecuado desempeño. OBJETIVOS: Diseñar un sistema de gestión integral de la cadena de frío de la Empresa Comercializadora y Distribuidora de Medicamentos EMCOMED, que permita garantizar la calidad de las operaciones de almacenamiento y transportación, y preservar la integridad de los productos farmacéuticos termosensibles durante su manipulación. MÉTODOS: Se realizó una búsqueda bibliográfica para seleccionar bibliografía actualizada y de rigor científico aplicable a la gestión de calidad de la cadena de frío. Se aplicó la técnica del diagrama causa-efecto para establecer las variables requeridas para el manejo integral de la cadena de frío y elaborar el procedimiento normalizado de operación (PNO) aplicable a las diferentes operaciones de la empresa. RESULTADOS: Se identificaron los cuatro elementos principales que permiten asegurar integralmente la calidad de la cadena de frío de EMCOMED. Se elaboró el PNO "Directrices para el manejo integral de la cadena de frío". CONCLUSIONES: El sistema de gestión de la cadena de frío de la empresa EMCOMED está basado en el aseguramiento de cuatro elementos principales. Las actividades necesarias para garantizar el manejo integral, están documentadas en un PNO. Su aplicación práctica reporta beneficios en los órdenes económico y social; y puede ser tomado como referente por empresas afines dedicadas a la distribución de productos termosensibles

INTRODUCTION: A solid cold chain is one that entirely assures all the necessary elements for an adequate performance. OBJECTIVE: To design a cold chain management system for the Cuban Wholesale Distribution Company of Pharmaceuticals EMCOMED that guarantees the quality of warehousing and transportation operations and the preservation of product integrity during handling. METHODS: A search was conducted to select updated bibliography with scientific rigor concerning the cold chain quality management system to be used as a reference. The cause-effect technique was applied to establish the necessary elements for the cold chain integral management and to draw up a standard operation procedure (SOP). RESULTS: Four main elements were identified to be necessary for establishing the cold chain management system of the company. The SOP "Guidelines for the cold chain integral management" was drawn up. CONCLUSIONS: The cold chain management system of EMCOMED is based on four main elements. The SOP drawn up, sets out the necessary activities for the cold chain quality assurance. Its practical application brings economic and social benefits to the company and it could be an example to other distribution companies of temperature sensitive products

Storage of vaccines in different health centers and pharmacies at Karachi, Pakistan: The handling errors.

The fundamental human desire is prevention from the infectious disease. Vaccine is the basic element to fulfill this human craving. The proper handling of vaccine can minimize the degradation. The main aim of this study is to find out the knowledge of respondents and storage condition and handling of marketed vaccines in different private clinics, hospitals and community pharmacies in Karachi, Pakistan. The present study revealed that ~77% have been allowed to visit their vaccine storage compartment. The cumulative knowledge of respondents regarding recommended temperature, shake test, thermal, freezing and photo degradation were 49.34%, 24.01%, 95.78%, 54.35% and 47.23% respectively. The major mishandling like the medicines, food and drinks and even laboratory specimen have been noticed 76.3%, 61.62% and 5.35% respectively. Moreover, water filled bottles on upper, lower and door shelves and ice packs or ice trays 3.43% and 14.18%, respectively, have been found in refrigerators and freezers, respectively. No expired vaccines have been found. The major consequence, in the study has been found to be mishandling by the absence of non-professional personnel. Either doctors or pharmacist (health associated professionals) as respondents were nearly all aware about the consequences of the mishandling of vaccines and have the knowledge about the recommended temperature, thermal, photo degradation, and freezing hazards of vaccines. The world-renowned immunization authorities have strongly recommended national/local immunization programs. On the basis of the present study, it is recommended to train the staff and prepare a national guideline for the storage and handling of vaccines, and forcefully implements the law to adopt the particular guideline.

Cold Chain Logistics Management of Medicine with an Integrated Multi-Criteria Decision-Making Method.

Medicine is the main means to reduce cancer mortality. However, some medicines face various risks during transportation and storage due to the particularity of medicines, which must be kept at a low temperature to ensure their quality. In this regard, it is of great significance to evaluate and select drug cold chain logistics suppliers from different perspectives to ensure the quality of medicines and reduce the risks of transportation and storage. To solve such a multiple criteria decision-making (MCDM) problem, this paper proposes an integrated model based on the combination of the SWARA (stepwise weight assessment ratio analysis) and CoCoSo (combined compromise solution) methods under the probabilistic linguistic environment. An adjustment coefficient is introduced to the SWARA method to derive criteria weights, and an improved CoCoSo method is proposed to determine the ranking of alternatives. The two methods are extended to the probabilistic linguistic environment to enhance the applicability of the two methods. A case study on the selection of drug cold chain logistics suppliers is presented to demonstrate the applicability of the proposed integrated MCDM model. The advantages of the proposed methods are highlighted through comparative analyses.

Assessment of factors affecting vaccine cold chain management practice in public health institutions in east Gojam zone of Amhara region.

BACKGROUND: Maintaining quality of vaccines is one of the main challenges of immunization programs in Ethiopia. The objective of this study is to assess the factor affecting vaccine cold chain management practice in immunization health institutions in East Gojam zone of Amhara region, Ethiopia. METHOD: An institutional based cross-sectional study was conducted from March to April 2017 in ten districts of East Gojam zone of Amhara Region. Descriptive statistics and Logistic regression analysis were carried out to identify factors related to the practice of cold chain management. RESULT: Among 60 health institutions, only 46(76.7%) had functional refrigerators. Twenty-one (35%) had a functional generator for backup service and 28(46.6%) had a car/motorbike for transportation of vaccines in case of refrigerator/power failure. Twenty-nine (48.3%) had known the correct vaccine storage temperature (2 °C - 8 °C) in the refrigerator and the results of this study revealed that only 23(38.3%) of respondents had sufficient knowledge about vaccine cold chain management. The finding of this study also revealed that 35(58.3%) had appropriate vaccine cold chain management practice and the rest 25(41.7%) had inappropriate practice. Logistic regression showed us the knowledge gap and profession were significantly associated with vaccine cold chain management practice at P < 0.05. CONCLUSION: This study indicates that there was a knowledge gap of health workers who are working on cold chain management. There is an urgent need to improve knowledge and practice on cold chain management through improved supervision and training at a different level of health care system.

Study on assessment of proximate composition and meat quality of fresh and stored Clarias gariepinus and Cyprinus carpio / Estudo da avaliação da composição centesimal e da qualidade da carne de Clarias gariepinus e Cyprinus carpio

Abstract The organoleptic evaluation and proximate analysis of Clarias gariepinus and Cyprinus carpio were determined in fresh fish and when refrigerated at two different temperatures (-21 °C and 4 °C) for a period of six weeks. A panel of twelve trained judges evaluated the color (live), texture, softness and flavor of fish meat after two minutes' steam cooking. Average score revealed a general decline in organoleptic properties such as color, texture, freshness, and taste of C. gariepinus and C. carpio stored at two temperatures compared to the fresh fish. Proximate analysis revealed a more decrease in crude protein and lipid contents and increase in ash content in C. gariepinus and C. carpio at the two storage temperatures compared to the fresh fish muscle. Moisture content decreased in the fish muscle samples of both the fish species stored at -21 °C but increased in the 4 °C stored samples. pH of fish was found to increase in the two stored temperatures. There were significant differences (P<0.05) in the organoleptic and proximate composition of the ice stored and fresh C. gariepinus and C. carpio, the same temperature and between the two different temperatures. The quality of fish muscle stored at 4 °C deteriorated faster than that of the -21 °C. Thus, storage temperature and duration have adverse effects on the nutritional quality of fish meat.

Resumo A avaliação organoléptica e a análise aproximada de Clarias gariepinus e Cyprinus carpio foram determinadas em peixe fresco e refrigerado a duas temperaturas diferentes (-21 °C e 4 °C) por um período de seis semanas. Um painel de doze juízes treinados avaliou a cor (ao vivo), textura, maciez e sabor da carne de peixe após dois minutos de cozimento a vapor. O escore médio revelou um declínio geral nas propriedades organolépticas, como cor, textura, frescor e sabor de C. gariepinus e C. carpio armazenados a duas temperaturas em comparação com o peixe fresco. A análise imediata revelou uma maior diminuição nos teores de proteína bruta e lipídios e aumento no teor de cinzas em C. gariepinus e C. carpio nas duas temperaturas de armazenamento em comparação com o músculo do peixe fresco. O teor de umidade diminuiu nas amostras de músculo de peixe de ambas as espécies de peixes armazenadas a -21 °C, mas aumentou nas amostras armazenadas a 4 °C. O pH dos peixes aumentou nas duas temperaturas armazenadas. Houve diferenças significativas (P <0,05) na composição organoléptica e próxima do gelo armazenado e fresco C. gariepinus e C. carpio, a mesma temperatura e entre as duas temperaturas diferentes. A qualidade do músculo do peixe armazenado a 4 °C deteriorou-se mais rapidamente do que a temperatura de -21 °C. Assim, a temperatura e duração do armazenamento têm efeitos adversos na qualidade nutricional da carne de peixe.

Collective construction of bundle for immunobiological agents conservation best practices.

OBJECTIVE: to construct collectively with nursing professionals bundle for best practices of cold chain maintenance of immunobiological agents conservation at the local level. METHOD: a qualitative research of convergent care type. Bundle construction was guided by the Evidence-Based Practice criterion. Data collection was carried out from October to December 2016, through five workshops, with the participation of 21 professionals from 7 vaccination rooms of a municipality of Minas Gerais State. The framework developed by Morse and Field was adopted for data analysis. RESULTS: through bundle, care is taken regarding refrigeration equipment temperature monitoring, contingency plan performance, recyclable ice coil setting and chamber use as refrigeration equipment. FINAL CONSIDERATIONS: the chosen interventions began to guide the practice and promote a care based on safety and quality.

Collective construction of bundle for immunobiological agents conservation best practices / Construcción colectiva de bundle para buenas prácticas de conservación de inmunobiológicos / Construção coletiva de bundle para boas práticas de conservação de imunobiológicos

ABSTRACT Objective: to construct collectively with nursing professionals bundle for best practices of cold chain maintenance of immunobiological agents conservation at the local level. Method: a qualitative research of convergent care type. Bundle construction was guided by the Evidence-Based Practice criterion. Data collection was carried out from October to December 2016, through five workshops, with the participation of 21 professionals from 7 vaccination rooms of a municipality of Minas Gerais State. The framework developed by Morse and Field was adopted for data analysis. Results: through bundle, care is taken regarding refrigeration equipment temperature monitoring, contingency plan performance, recyclable ice coil setting and chamber use as refrigeration equipment. Final considerations: the chosen interventions began to guide the practice and promote a care based on safety and quality.

RESUMEN Objectivo: construir colectivamente, con profesionales de enfermería, bundle para buenas prácticas de mantenimiento de la cadena de frío de conservación de inmunobiológicos a nivel local. Método: investigación cualitativa del tipo convergente asistencial. La construcción del bundle fue guiada por los criterios de la Práctica Basada en Evidencias. La recolección de datos fue realizada en el período de octubre a diciembre de 2016, por medio de cinco talleres, con la participación de 21 profesionales de 7 salas de vacunación de un municipio del estado de Minas Gerais. Para el análisis de los datos, se adoptó el referencial de Morse y Field. Resultados: por medio del bundle, se contemplan cuidados relativos al monitoreo de la temperatura del equipo de refrigeración, ejecución del plan de contingencia, ambientación de la bobina de hielo reciclable y el uso de la cámara como equipo de refrigeración. Consideraciones finales: las intervenciones elegidas pasaron a guiar la práctica y promover un cuidado pautado en la seguridad y calidad.

RESUMO Objetivo: construir coletivamente, com profissionais de enfermagem, bundle para boas práticas de manutenção da cadeia de frio de conservação de imunobiológicos em nível local. Método: pesquisa qualitativa do tipo convergente assistencial. A construção do bundle foi norteada pelos critérios da Prática Baseada em Evidências. A coleta de dados foi realizada no período de outubro a dezembro de 2016, por meio de cinco oficinas, com a participação de 21 profissionais de 7 salas de vacinação de um município de Minas Gerais. Para análise dos dados, adotou-se o referencial de Morse e Field. Resultados: por meio do bundle, contemplam-se cuidados relativos ao monitoramento da temperatura do equipamento de refrigeração, execução do plano de contingência, ambientação da bobina de gelo reciclável e o uso da câmara como equipamento de refrigeração. Considerações finais: as intervenções eleitas passaram a nortear a prática e promover um cuidado pautado na segurança e qualidade.