Immunization Fridge Survey Update

Two months ago, the Fridge Militia (as I like to call them) was interested in getting some sense of the state of immunization vaccine refrigerators. How many practices actually use medical quality equipment?  How common are generators?  How many doctors actually have two-way communication with their valuable resources?  The improvement of vaccine storage is an overlooked, yet incredibly important, aspect of pediatric healthcare delivery and I applaud the effort of the AAP, Dr. Barden, and Dr. Warner.

To the survey.  We received nearly 100 responses from practices of all sizes, spread out among practices around the country.

Of the fridges we accounted for, 60% of them are medical grade and 40% of them are commercial/domestic.  For practices who have >1 fridge, many of them are “mixed” – that is, they have at least one of each level of equipment.  I can’t say this scientifically, but I suspect that many practices are replacing their older fridges as they break down with new, medical grade units but keeping the ones that still work.  To my surprise, 10% of the practices had stand alone freezers as well, but we didn’t ask details about that equipment.

Of the medical grade fridges, 90% have a digital thermometer.

Among all the fridges, 75% have at least one digital Mon/Max thermometer.  65% additionally include data logging (yay!).

I was surprised to see that 55% of the fridges have some level of communication monitor in the event of a temperature or power problem.  Of course, two way communication is a vital part of this strategy (so you keep getting alerts until they are acknowledged), and it appears that most people have this functionality.

We wanted to get some sense of whether the size of the practice and/or the volume of stored vaccines has any effect on these numbers.  Do larger practices have a better vaccine storage program?  The answer appears to be…that there’s no correlation.  We looked at the size of private vaccine inventory – from $5K to $250K (average: $60K, median: $50K) – we didn’t see any measurable difference in use of medical grade equipment.

We also looked at VFC distribution (with inventories ranging from $0 to $500K(!), but a median of $20K) and it had no effect either.

When we asked the question, “Would it speed your adaptation of better refrigerators if the documentation for VFC inspections were considerably easier for the electronic medical grade refrigerators?” the answer was…yes.  It would help a lot.  No surprise there.  This is a good sign for the vendors pushing into the new automated storage arena.

We learned that the overwhelming number of respondents work with some kind of GPO to purchase private vaccines…but there are some who do not!  Please join a GPO, any GPO!  Especially when 20% of them have negotiated better pricing on medical fridges.

What do we take from all this?  I don’t have data from, say, 10 years ago but my gut tells me that the use of medical grade vaccine storage is on the rise.  I know, from visiting too many offices to count, that medical grade fridges were a small sliver of the equipment installed.  Today, they are the majority.

You can, and you should, use the proper equipment!


10 thoughts on “Immunization Fridge Survey Update

  1. Thanks for doing this work! It is nice to get a snap shot of the world, warts and all. I do think the message that vaccines are too valuable to Society and the Patient to trust to units not specifically designed to hold vaccine! I am reminded of this last week when I pulled some dinner out of my home refrig and found ice in among the grapes! Practices with VFC inspector traffic will make the switch – it is the private practices with NO Medicaid/VFC vaccines that I am worried about. Ironic that the practices with the thinnest margins are the ones with the best vaccine refrigerators!

  2. Great work Chip- thanks for doing this survey- What did the generator data look like?
    I agree with Graham, I worry about vaccine storage in the practices with no VFC and therefore no inspection.

    • I totally forgot to mention the generator data (it’s right there in my notes!).
      35%. I would have guessed…20%. So that’s good news.

      I did go through and try to find a correlation between VFC usage and better fridges – our data sample is too small to see anything significant. Yes, those with 0% VFC (and it’s not many) have a 40/60 split of medical grade vs. commercial+domestic (instead of the 60/40), but there aren’t enough to say for sure. On the other end, those with >50% VFC are no better, though the sample is really worse.

      The fact is, we know we are fishing in the pond of good practices. I suspect, both logically and from experience, that you’re right.

      Which implies that gov’t intervention IS better sometimes 🙂 Let’s see if Dr. Barden sees this comment.

      • And Chip, I DO think Government is great when they agree with me! The VFC program has an obligation to be sure the VFC funds are cared for appropriately. Remember, the VFC budget in the CDC is OVER HALF their annual budget! And for their oversight, they give us free vaccine we can use on our uninsured/Medicaid patients which makes up 40% of my patients. I need the Feds! I do wish they would lean on the local state VFC programs to hold us “not responsible” for losses over $1000. I am not sure why they don’t since the CDC really does not want us penalized. (It is the state VFC programs that want the Big Stick of whacking us if vaccine gets damaged.)

  3. We have a medical grade refrigerator with on site and off site monitoring. It was quite an expensive endeavor. Perhaps if the vaccine companies would subsidize this effort to ensure the effectiveness of their vaccines the rate of implementation would even be higher. BTW we also installed a generator after superstorm Sandy.

    • My understanding is that there are legal limitations to them supporting this endeavor, otherwise I agree with you 110%. I think they should be like Coke machines, even. Why not have a giant Sanofi fridge, the best money can buy? It assure the quality of their product. But, apparently, it’s not allowed. Too bad!

      As for the expense, check out Dr. Barden’s reply from a few weeks ago. He provides an excellent example of how one of these better fridges can pay for itself quite quickly.

  4. It would be so helpful if the states supplying the vaccines had a program of some sort to help with the cost of the medical grade fridges and freezers. 98% of our vaccine is State supplied, we are a $160,000 average per year practice, which is quite stressful when you think about being held responsible for all that vaccine if something were to go wrong. We’ve recently looked into medical grade freezers and the cost was just too our of reach. So, for now, we “sit on the freezer (and fridge) like a mother hen” to be sure we are right on top of it if anything should start to go wrong, as we’ve all ready experienced that with our previous fridge (which was NOT all that old at the time we had to replace it). I guess it helps keep us on our toes!

    • > It would be so helpful if the states supplying the vaccines had a program of some sort to help with the cost of the medical grade fridges and freezers.

      I couldn’t agree more, except that most state health departments have no budget. VFC has become punitive and combative instead of collaborative and supportive, which is really sad.

    • Jen, I would be glad to help you tune your vaccine storage. A great vaccine refrigerator is around $3,000 to $4,000. A phone enabled monitor that can call if there is a problem is about $350 on Amazon and a good data logger is $160. A small adequate freezer for 4 docs is <$200. This is not as expensive as it seems! Plus, you can take advantage of the discounts you realize by buying large amts of vaccine prior price changes. We saved $10,000 this year and $9,000 last year. So you do not need a sponsor for your refrigerator – you can do this yourself and save money over 3 years. contact me directly – if you'd like volunteer help.

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