The 12 Deadly Sins of Medical Cold Chain Handling

Cold-chain medical products are time—and temperature-sensitive and require stringent adherence to the manufacturer’s recommended storage conditions. If not respected, these conditions lead to degradation that affects the product’s efficacy and, in some cases, the patient’s safety.

In this post, I would like to discuss some cold chain practices. Some may be well-intentioned but actually have quite a detrimental effect. Most of these are due to a knowledge gap, while others could be due to a fortunate lucky streak until the black swan shows up.

Let’s delve into the 12 deadly sins of cold chain handling. Number 10 will shock you! I’m just kidding, but please do read to the end.

1. The first and most deadly sin you will not see coming is assuming that the people supplying you with cold chain products must know what they are doing. Assuming that your source distributor or transporter of cold chain products has a reliable and perfect system that doesn’t warrant your risk assessment could prove detrimental if poor-quality cold chain products find their way into your supply chain and, even worse, to your customers.
2. Nothing has gone wrong, so nothing will. Systems, especially those dependent on human factors, are inherently predisposed to risk, and cold chains are no exception. In cold chains, the critical risks include overreliance on one power source, such as the national electricity grid without backup, reliance on a single source, or reliance on a single transporter. Murphy’s law dictates that whatever could go wrong will eventually go wrong.
3. The colder it is, the better it is. Have you ever bought a cold chain medicine wrapped up in contact with a frozen ice pack? While the intention to keep the drug cool is apparent, the freezing temperatures actually damage the product and may render it ineffective or even dangerous to your health. At the distributor level, there is the tendency to use the coldest, most frozen-up ice packs when packing cold chain consignments, especially those destined for further destinations. While the product may reach its intended destination within the required cool temperatures, it may also have been freeze-damaged and denatured… no, bubble wrap and paper envelopes around the ice packs don’t cut it.
4. Styrofoam is the King of cold chain packaging, right? No. While it’s essentially a poor conductor of heat, it is insufficient to protect cold chain items against external temperatures without additional insulation.
5. Gut feeling over temperature monitoring—Temperature monitoring remains the most reliable way of establishing the actual conditions of storage and transportation. While there is a place for validating the transportation equipment, route, and processes, unforeseen events may compromise the process, leading to a complicated decision-making process on the final disposition of affected cold chain products without data to guide.
6. How hard can this be? The tendency to undertake cold chain processes casually without clear procedures and formal personnel training is common and detrimental to the integrity of the process and products. This is stressful for the personnel undertaking the cold chain packing, and it undermines whatever cold chain infrastructural capabilities are in place. 
7. Leave nothing behind; fill it to the brim. Maximizing capacity for obvious logistical considerations requires overpacking cold chain parcels. This prevents adequate air circulation and even temperature distribution and may predispose some items to damage.
8. They are stable; a little heat won’t hurt. The temptation to do a quick run of a cold chain item without proper cold chain packing for what can be considered a short distance and, therefore, low or negligible risk is always there. However, I say to resist and pack the cold chain suitably.
9. Hey! My lunch needs the fridge, too. Employees often use the refrigerator at the retail chemist or warehouse to keep their lunch fresh and their smoothies cool. This poses a risk of contamination of medical products by foodstuffs, an infestation of pests, and food that may also get contaminated by the chemicals in the products. It also leads to opening the fridge many times, interfering with the cooling process.
10. It’s okay to keep your medicines at the door of your refrigerator. The fridge door is not as cool as the interior; therefore, any cold chain medicine at home should be well secured and placed inside the fridge. Ideally, pharmaceutical-grade refrigerators should be used at the retail and distributor levels, and these do not have this door storage compartment.
11. Your aluminum foil lunch bag will keep your cold chain drugs cold. This fallacy is an urban myth that gives some mental comfort that your cold chain product will stay cool in this lunch bag without additional passive or active cooling sources. The insulation only momentarily helps to keep your food warm and your salad cool.
12. The final sin of which many are guilty (even as professionals when we become patients) is the expiry date. The expiry date is a suggestion; I kept it in the refrigerator! We do our own quality checks for the milk and juice in the fridge after the indicated expiry date and give them a thumbs up. We can’t do this for medicines, vaccines, reagents, or any other medical cold chain products because their safety and efficacy depend on their shelf life.

Stay tuned for the coming posts as we dig deeper into each sin and find redemption anchored on sound quality standards and practical solutions available to us.