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PubMed1999

Vaccine storage practices in primary care physicians' offices in Taiwan.

To assess vaccine storage practices in Taiwan's clinics, an evaluation was made to determine whether they follow the relevant guidelines. A cross sectional study was carried out in March 1994, in which sixty-three clinics were selected at random from the 744 clinics in the twenty-one counties of Taiwan. Vaccine storage practices were inspected and the temperature of the central core of refrigerators used by these clinics for vaccine storage was measured. Of the 63 clinics, the majority (93.7%) stored articles other than vaccines in their vaccine refrigerators. Thirty clinics (47.6%) placed simple thermometers in their refrigerators; twenty-nine clinics (46.0%) used recording thermometers to produce temperature charts; and 25 clinics (39.7%) equipped their refrigerators with UPS (uninterruptable power system). Forty (63.5%) of 63 vaccine coordinators who were interviewed indicated at least one power failure per year. All refrigerators used for vaccine storage were of the domestic type without "safe zone" gauges. We discovered inappropriately high temperatures (> 8 degrees C) in 22% (14/63) of all refrigerators. Most refrigerator doors (76.3%, 45/59) or freezing rooms (73.7%, 28/38) were not maintained at a temperature required for storing vaccine. Coordinators should be carefully trained and refrigeration and electrical facilities be reassessed to improve vaccine storage in primary care physicians' offices.

Primary Health Care↗
PubMed2006

Stability and viscosity of a flavored omeprazole oral suspension for pediatric use.

PURPOSE: The stability and viscosity of preparations of a commercially available, flavored, immediate-release powder for oral suspension (omeprazole-sodium bicarbonate) during refrigerator and room temperature storage were investigated. METHODS: Omeprazole-sodium bicarbonate 20-mg packets were suspended to initial omeprazole concentrations of 0.6 and 2 mg/mL, and omeprazole-sodium bicarbonate 40-mg packets were suspended to initial omeprazole concentrations of 1.2, 2, 3, and 4 mg/mL. Suspensions were stored at 4 degrees C in darkness (refrigerated) or 22-25 degrees C (room temperature) in light for one week. A third set of suspensions was stored refrigerated for one month. Omeprazole's stability was quantified after 0, 6, 12, 24, 48, and 168 hours in one-week samples and after 0, 7, 14, 21, and 28 days in one-month samples using high-pressure liquid chromatography. Viscosities of refrigerated suspensions were measured after 0, 1, and 7 days. RESULTS: Refrigerated suspensions retained >98% and >96% of their initial omeprazole concentrations after one week and one month, respectively. Stability of room temperature suspensions was concentration dependent. After one week, the 0.6- and 1.2-mg/mL suspensions retained 87.2% and 93.1% of their respective initial omeprazole concentrations, whereas the 2-, 3-, and 4-mg/mL suspensions retained >97% of their initial omeprazole concentrations. Suspension viscosities varied 10-fold over the concentrations studied, but all were within the viscosity ranges of other commercially available oral suspensions. Prolonged refrigeration did not increase the suspensions' viscosities. CONCLUSION: Omeprazole-sodium bicarbonate suspensions of 0.6-4 mg/mL omeprazole were stored at 4 degrees C in darkness for up to 28 days. The viscosities of refrigerated suspensions did not increase over 7 days. Except for the 0.6 mg/mL preparations, suspensions stored at room temperature in the light retained >90% of their initial omeprazole content after 7 days, despite turning yellow.

Administration, Oral↗
PubMed2002

Evaluation of preservation methods for nutrient species collected by automatic samplers.

Automatic samplers are a common method of data collection for numerous monitoring projects in the South Florida region and elsewhere. Although total phosphorus (TP) is the primary parameter of interest within this region, nitrogen species such as ammonia nitrogen (NH4-N), nitrate+nitrite nitrogen (NOx-N), and total kjeldahl nitrogen (TKN) are also collected and analyzed. Federal and state quality assurance guidelines require nutrient samples to be preserved by acidification with H2SO4 to a pH < 2 and stored immediately at 4 degrees C. However, the remoteness of many sampling locations in South Florida makes it difficult to supply electricity for the refrigeration of samples collected by autosamplers. In addition, the use of propane-powered refrigerated autosamplers is a costly and ineffective solution in the South Florida climate. Consequently, while samples collected at these remote locations are routinely pre-preserved with acid, they are not cooled to 4 degrees C for a period from one to seven days. This study evaluated if a statistically significant difference (approximately = 0.05) existed between concentrations of nitrogen species from a common source sample that was either: processed immediately; refrigerated to 4 degrees C for seven days; or not refrigerated for seven days. In all cases, the collected sample was pre-preserved by adding 1 mL of 50% H2SO4 to each 1 L discrete sample container before each 7 day testing period. Differences in concentrations of the calculated parameter total nitrogen (TN) were also investigated. Analyses using the Wilcoxon Signed-Rank Test showed no significant differences among the three treatment groups for NOx-N, TKN, TN and TP. Significant differences were observed when the NH4-N samples that were processed immediately were paired with NH4-N samples that were left unrefrigerated or refrigerated for seven days. Information from this study can be used by researchers and managers in evaluating the usefulness of nutrient water quality data that is collected when sample refrigeration is not available.

Automation↗
PubMed1995

Vaccine storage and handling. Knowledge and practice in primary care physicians' offices.

OBJECTIVE: To assess the knowledge and practice of vaccine storage and handling in primary care physicians' offices. DESIGN: A cross-sectional study was conducted from August to December 1992. Staff responsible for vaccine storage were interviewed about their knowledge and practices of vaccine handling and storage. Refrigerators were inspected to document refrigerator temperature and vaccine storage conditions. SETTING: General and pediatric practices in 12 regions of Ontario. PARTICIPANTS: Practices outside metropolitan Toronto were selected by choosing every 10th physician who ordered vaccine from the local health department in 1992. Practices chosen in metropolitan Toronto were a random selection of physicians affiliated with a Toronto teaching hospital. Eighteen pediatric and 138 general practices were approached to participate; 12 pediatric and 123 general practices participated in the study. The overall response rate was 86.5%. MAIN OUTCOME MEASURES: Survey responses and temperature and storage conditions of refrigerators upon inspection. RESULTS: Fewer than seven (6%) practices answered all questions related to vaccine storage and handling correctly, and only 11 (10%) refrigerators had thermometers. One-third of refrigerators had temperatures outside the recommended range of 2 degrees C to 8 degrees C. Older refrigerators were more likely to have inappropriate temperatures than newer ones. CONCLUSIONS: Knowledge and practice of vaccine storage and handling are often inadequate in primary care physicians' offices.

Clinical Competence↗
PubMed2002

Storage stability of Anagrapha falcifera nucleopolyhedrovirus in spray-dried formulations.

A multiply embedded nucleopolyhedrovirus isolated from Anagrapha falcifera (Kirby) (AfMNPV) can lose insecticidal activity during months of dry storage in ambient room conditions. We tested the spray-dried AfMNPV formulations after storage for up to 1 year at room temperatures for insecticidal activity against neonate Trichoplusia ni (Hübner). Experimental formulations were made using combinations of corn flours, lignin, and sucrose, and were selected based on previous work which demonstrated that these formulations resisted solar degradation in field experiments. Twelve experimental formulations (organized in three groups of four formulations) compared the effect of (1) the ratio of formulation ingredients (lignin and corn flour) to virus concentration, (2) different sources of lignin, or (3) different corn flours and sugar. Based on a single-dose plant assay with these 12 formulations, none of the formulations lost significant activity due to the drying process, when compared with the unformulated wet AfMNPV. Samples of the 12 dried formulations were stored at room (22+/-3 degrees C) and refrigerated (4 degrees C) temperatures. Insecticidal activity (LC(50)) was determined with a dosage-response assay for neonates fed on treated cotton-leaf disks. After 6 (or 9) and 12 months storage, refrigerated samples maintained insecticidal activity better than corresponding samples stored at room temperatures with LC(50)s that averaged 2.0 x 10(6) polyhedral inclusion bodies per milliliter (pibs/ml) for refrigerated samples and 5.4 x 10(6) pibs/ml for samples stored at room temperatures. Compared with unformulated stock virus stored frozen, six formulations stored at room temperature and 10 formulations stored in the refrigerator did not lose significant insecticidal activity after 1 year based on overlapping 90% confidence intervals. Changing the ratio of virus to formulation ingredients did not provide a clear trend over the range of concentrations tested, and may be less important for shelf-life of virus activity compared with formulations made with different ingredients. Two of the four formulations made with different lignins were about 15 times less active after 1 year at room temperature compared with refrigerated samples, indicating that specific formulation ingredients can affect storage stability. Formulations that contained sugar generally maintained activity during storage better than formulations without sugar. Unformulated virus stock maintained insecticidal activity (ranged from 0.20 to 2.5 x 10(6) pibs/ml) better during storage than dried formulations with LC(50)s that ranged from 0.39 to 27 x 10(6) pibs/ml. Unformulated virus stock, which is essentially a suspension of virus occlusion bodies in homogenized insect cadavers, did not lose activity when stored at refrigerated or room temperature. We believe that stability of AfMNPV insecticidal activity during storage as dry formulations is related to the general composition of the formulation and that sugar may play a critical role in maintaining insecticidal activity.

Animals↗
PubMed2006

The effect of temperature on the antimicrobial activity of Optisol-GS.

PURPOSE: To determine the survival of different bacteria inoculated in Optisol-GS at refrigerated storage temperature (6 degrees C) and after subsequent warming to room temperature (19-22 degrees C). METHODS: Staphylococcus aureus, Enterococcus faecium, Streptococcus pneumoniae, and Pseudomonas aeruginosa were chosen from stock clinical isolates for inclusion in the study. The first group consisted of 12 Optisol-GS vials. The second group consisted of 12 Optisol-GS vials containing corneas inappropriate for transplantation according to the Eye Bank Association of America (EBAA) protocols. Each group was inoculated with 3 concentrations of approximately 10, 10, and 10 colony-forming units (CFU)/mL of each bacterial species and then refrigerated per EBAA protocol. After 48 hours of refrigeration, all vials were placed at room temperature (RT) and counts were performed at 48, 50 (2 hour RT), 54 (6 hour RT), 60 (12 hour RT), 72 (24 hour RT), and 96 (48 hour RT) hours. At 96 hours, the corneal tissue from 10 and 10 inocula were cultured. All samples underwent serial dilution, spiral plating on blood agar plates, and incubation at 35 degrees C. Viable colony counts were determined at 24 hours. RESULTS: Except for the 10 CFU/mL inocula of P. aeruginosa, all isolates were viable after 48 hours of refrigeration. Rapid bactericidal activity was observed against P. aeruginosa after 2 hours at RT, with complete sterilization by 6 hours. The rate and extent of killing against S. aureus were influenced by the initial inoculum. Bactericidal activity was achieved after 2 hours at RT with 10 CFU/mL of S. aureus versus 24 hours with the 10 inoculum. Of note, bactericidal activity was not observed against S. pneumoniae and E. faecium following 24 hours of storage at RT. The presence of corneal tissue did not affect viable counts, with counts from corneal tissue cultures reflecting the counts seen from Optisol-GS after 48 hours at RT. CONCLUSIONS: The antimicrobial activity of Optisol-GS was reduced at refrigerated temperature and enhanced at RT. Bactericidal activity was not observed against E. faecium at either refrigerated temperature or RT.

Anti-Bacterial Agents↗
PubMed2002

Theory of inert gas-condensing vapor thermoacoustics: transport equations.

The preceding paper [J. Acoust. Soc. Am. 112, 1414-1422 (2002)] derives the propagation equation for sound in an inert gas-condensing vapor mixture in a wet-walled pore with an imposed temperature gradient. In this paper the mass, enthalpy, heat, and work transport equations necessary to describe the steady-state operation of a wet-walled thermoacoustic refrigerator are derived and presented in a form suitable for numerical evaluation. The requirement that the refrigerator operate in the steady state imposes zero mass flux for each species through a cross section. This in turn leads to the evaluation of the mass flux of vapor in the system. The vapor transport and heat transport are shown to work in parallel to produce additional cooling power in the wet refrigerator. An idealized calculation of the coefficient of performance (COP) of a wet-walled thermoacoustic refrigerator is derived and evaluated for a refrigeration system. The results of this calculation indicate that the wet-walled system can improve the performance of thermoacoustic refrigerators. Several experimental and practical questions and problems that must be addressed before a practical device can be designed and tested are described.

Acoustics↗
PubMed2006

Influence of raw milk quality on fluid milk shelf life.

Pasteurized fluid milk shelf life is influenced by raw milk quality. The microbial count and somatic cell count (SCC) determine the load of heat-resistant enzymes in milk. Generally, high levels of psychrotrophic bacteria in raw milk are required to contribute sufficient quantities of heat-stable proteases and lipases to cause breakdown of protein and fat after pasteurization. Sanitation, refrigeration, and the addition of CO2 to milk are used to control both total and psychrotrophic bacteria count. It is not uncommon for total bacterial counts of raw milk to be < 10,000 cfu/mL. In the past, fluid milk processors have not focused much attention on milk SCC. Increased SCC is correlated with increased amounts of heat-stable protease (plasmin) and lipase (lipoprotein lipase) in milk. When starting with raw milk that has a low bacterial count, and in the absence of microbial growth in pasteurized milk, enzymes associated with high SCC will cause protein and fat degradation during refrigerated storage, and produce off-flavors. As the ability to kill, remove, or control microbial growth in pasteurized refrigerated milk continues to improve, the original milk SCC will be the factor limiting the time of refrigerated storage before development of an off-flavor in milk. Most healthy cows in a dairy herd have a milk SCC < 50,000 cell/mL. Bulk tank SCC > 200,000 cell/mL are usually due to the contribution of high SCC milk from a small number of cows in the herd. Technology to identify these cows and keep their milk out of the bulk tank could substantially increase the value of the remaining milk for use in fluid milk processing. To achieve a 60- to 90-d shelf life of refrigerated fluid milk, fluid processors and dairy farmers need to work together to structure economic incentives that allow farmers to produce milk with the SCC needed for extended refrigerated shelf life.

Animals↗
PubMed1981

Effects of storage time and temperature on quantitative culture of canine urine.

Results of quantitative culture of 25 canine urine samples stored at different temperatures for varying periods (2, 4, 6, 12, and 24 hours) following collection were compared. Samples stored at room temperature (21 to 25 C) were unreliable for diagnostic quantitative culture after 24 hours. False-positive results were obtained in 13 (50%) of the samples, and false-negative results were obtained in 1 (4%) sample. Likewise, samples sent via the US mail were unreliable for diagnostic quantitative culture since false-positive results were obtained in 9 (35%) of the samples. Samples stored at refrigeration temperature (3 to 8 C) provided more satisfactory data. Culture of urine samples refrigerated for 2 hours resulted in quantitative results that were similar and interpretations that were identical to those obtained for samples cultured without having been refrigerated. Refrigeration for periods up to 6 hours resulted in qualitative counts that differed from those obtained after initial culture of the nonrefrigerated samples, but interpretations of results were identical. After 24 hours of refrigeration there were no false-positive results; however, false-negative results were observed in 1 (4%) of the samples. These observations indicated that optimal results of quantitative culture of urine can be consistently obtained only if samples are immediately processed following collection. If immediate culture is not possible, the specimens may be stored for at least 6 hours at refrigeration temperature without compromising the validity of results.

Animals↗
PubMed2004

Oxidative status of human milk and its variations during cold storage.

Breastfeeding and human milk are widely accepted as optimal for human infants' nutrition. Nowadays lifestyle often makes it difficult to maintain or even initiate human lactation. This situation is mostly related to the workload of women away from home. New approaches are needed to enable maternal lactation under these circumstances. Human breastmilk storage for differed use is one possibility. The aim of this study was to assess changes in glutathione peroxidase (GPx) activity and in the concentration of the lipid peroxidation marker, malondialdehyde (MDA), when human milk was kept refrigerated or frozen. Thirty-two human milk samples were assayed for GPx activity and MDA concentration. Samples were divided in three aliquot portions, the first to be immediately analysed, the second to be refrigerated at 4 degrees C and analysed 24 h thereafter, and the third to be frozen at -20 degrees C and assayed after 10 days. GPx activity was significantly decreased in refrigerated and in frozen milk, when compared to their control samples. MDA was increased only in refrigerated milk but not in frozen samples. Thus, freezing seems better than refrigeration in order to prevent lipid peroxidation in stored human milk samples.

Adult↗
PubMed2006

Bactericidal activity of human milk: stability during storage.

Human milk provides infants with defensive factors against many illnesses. This study aims to analyse global bactericidal activity in fresh human milk and evaluate its stability in relation to milk manipulation and its possible alteration following refrigeration. Nineteen milk samples (mature milk) from 19 healthy women are analysed. Viability testing involving a strain of Escherichia coli NCTC 9111, serovar O111:K58(B4):H- was used to determine the bactericidal effect of human milk. Degree of bacteriolysis is calculated as the difference between E. coli counts in controls and in milk samples, expressed as a percentage of the control sample counts. An evaluation of the effect of refrigeration at 4-6 degrees C after 24, 48 and 72 hours, and at -20 degrees C for seven days on bactericidal capacity is made. Bactericidal activity was detected in all milk samples analysed (77.33 +/- 15.14%). This activity persisted after refrigeration for 48 hours and after freezing for 10 days, but showed a significant decrease after refrigeration for 72 hours. In conclusion, maternal milk has bactericidal capacity, providing defence and protection against infection for newborn infants. This property can be altered during the storage of milk. Consequently, if storage in excess of 48 hours is required, freezing is preferable to refrigeration.

Anti-Bacterial Agents↗
PubMedDate not supplied

Home-prepared saline: a safe, cost-effective alternative for wound cleansing in home care.

OBJECTIVE: The purpose of this study was to determine (1) the rate of contamination for a normal saline solution prepared with distilled water and salt when stored at room temperature and (2) when stored under refrigerated conditions; and (3) to compare the rate of contamination for solutions prepared and stored under controlled conditions with those prepared and stored in patients' homes. DESIGN: This quasi-experimental study examined the bacterial content of saline made with distilled water and stored at room temperature and that of saline stored in a refrigerator. SETTING: A large urban home health agency was the setting for the study. METHODS: Eight teaspoons of table salt were added to 1-gallon jugs of distilled water purchased from a grocery store to produce a normal saline solution. Two gallons of the prepared solution were stored at room temperature (80 degrees F) and 2 were stored in a refrigerator (48 degrees F). Cultures were taken from each of the 4 bottles of prepared solution immediately following preparation and at weekly intervals until bacterial growth occurred, or 4 weeks after preparation. RESULTS: All tested solutions were negative for bacterial growth at baseline. Cultures of the solution stored at room temperature were positive for bacterial growth 2 weeks after preparation, whereas those stored under refrigerated conditions remained free of bacterial contamination 4 weeks after preparation. Two "patient-prepared" solutions were tested at 3 weeks, and both were negative for bacteria at that time. Three patient-prepared solutions were tested at 4 weeks, of which 2 showed no bacterial growth in 48 hours, whereas 1 revealed 600 cfu/mL of Pseudomonas species. CONCLUSIONS: The results of this small study suggest that saline solutions produced by adding table salt to distilled water will remain bacteria-free for 1 month if refrigerated. Additional studies are needed to confirm these findings.

Clinical Nursing Research↗
PubMed2004

Survival of cold-stressed Campylobacter jejuni on ground chicken and chicken skin during frozen storage.

Campylobacter jejuni is prevalent in poultry, but the effect of combined refrigerated and frozen storage on its survival, conditions relevant to poultry processing and storage, has not been evaluated. Therefore, the effects of refrigeration at 4 degrees C, freezing at -20 degrees C, and a combination of refrigeration and freezing on the survival of C. jejuni in ground chicken and on chicken skin were examined. Samples were enumerated using tryptic soy agar containing sheep's blood and modified cefoperazone charcoal deoxycholate agar. Refrigerated storage alone for 3 to 7 days produced a reduction in cell counts of 0.34 to 0.81 log10 CFU/g in ground chicken and a reduction in cell counts of 0.31 to 0.63 log10 CFU/g on chicken skin. Declines were comparable for each sample type using either plating medium. Frozen storage, alone and with prerefrigeration, produced a reduction in cell counts of 0.56 to 1.57 log10 CFU/g in ground chicken and a reduction in cell counts of 1.38 to 3.39 log10 CFU/g on chicken skin over a 2-week period. The recovery of C. jejuni following freezing was similar on both plating media. The survival following frozen storage was greater in ground chicken than on chicken skin with or without prerefrigeration. Cell counts after freezing were lower on chicken skin samples that had been prerefrigerated for 7 days than in those that had been prerefrigerated for 0, 1, or 3 days. This was not observed for ground chicken samples, possibly due to their composition. C. jejuni survived storage at 4 and -20 degrees C with either sample type. This study indicates that, individually or in combination, refrigeration and freezing are not a substitute for safe handling and proper cooking of poultry.

Animals↗
PubMed1979

Evaluation of preservative fluid for urine collected for culture.

Immediate culture or refrigeration of urine is recommended, but not always practical. Therefore, we evaluated the Becton-Dickinson Urine Culture Kit containing a boric acid-glycerol-sodium formate preservative in a study of 1,000 clinical urine specimens. Each specimen was cultured a total of four times by the surface streak technique with a 0.001-ml calibrated loop. After an initial reference culture (culture 1), a portion of urine was poured into a clean nonsterile paper cup, aspirated into a urine transport tube, and recultured immediately (culture 2). The original specimen cup was refrigerated for 18 to 24 h (culture 3), and the urine transport tube was held at room temperature for 18 to 24 h (culture 4) before repeat cultures. Eighty-eight of the initial reference cultures were positive (pure growth of greater than 10(5) bacteria per ml). Eighty-two (93.2%) of the 88 specimens positive on the reference culture were also positive after refrigeration or holding at room temperature in the transport tube for 24 h. There was one false-positive culture from refrigerated urine but none from the transport tube. Mixing of urine in a nonsterile container did not introduce detectable contamination. We conclude that the Becton-Dickinson Urine Culture Kit maintains a stable bacterial population in urine for up to 24 h as reliably as refrigeration. Urine for culture may be collected in a nonsterile container if it is immediately aspirated into the transport tube so that contaminants are not allowed to multiply.

Bacteria↗
PubMed2001

Risk factors for improper vaccine storage and handling in private provider offices.

CONTEXT: Preventing loss of vaccine potency during storage and handling is increasingly important as new, more expensive vaccines are introduced, in at least 1 case requiring a different approach to storage. Little information is available about the extent to which staff in private physicians' offices meet quality assurance needs for vaccines or have the necessary equipment. Although the National Immunization Program at the Centers for Disease Control and Prevention (CDC) in 1997 developed a draft manual to promote reliable vaccine storage and to supplement published information already available from the CDC and the American Academy of Pediatrics, the best ways to improve vaccine storage and handling have not been defined. OBJECTIVES: To estimate the statewide prevalence of offices with suboptimal storage and handling, to identify the risk factors for suboptimal situations in the offices of private physicians, and to evaluate whether the distribution of a new National Immunization Program draft manual improved storage and handling practices. DESIGN: Population-based survey, including site visits to a stratified, random sample of consenting private physicians' offices. At least 2 months before the site visits, nearly half (intervention group) of the offices were randomly selected to receive a draft CDC manual entitled, "Guideline for Vaccine Storage and Handling." The remainder was considered the control group. Trained graduate students conducted site visits, all being blinded to whether offices were in the intervention or control groups. Each site visit included measurements of refrigerator and freezer temperatures with digital thermometers (Digi-thermo, Model 15-077-8B, Control Company, Friendswood, TX; specified accuracy +/- 1 degrees C). Their metal-tipped probes were left in the center shelf of cold storage compartments for at least 20 minutes to allow them to stabilize. The type of refrigerator/freezer unit, temperature-monitoring equipment, and records were noted, as were the locations of vaccines in refrigerator and freezer, and the presence of expired vaccines. Other information collected included the following: staff training, use of written guidelines, receipt of vaccine deliveries, management of problems, number of patients, type of office, type of medical specialty, and the professional educational level of the individual designated as vaccine coordinator. PARTICIPANTS: Two hundred twenty-one private physicians' offices known by the Georgia Immunization Program in 1997 to immunize children routinely with government-provided vaccines. OUTCOME MEASURES: Estimates (prevalence, 95% confidence interval [CI]) of immunization sites found to have a suboptimally stored vaccine at a single point in time, defined as: vaccine past expiration date, at a temperature of </=1 degrees C or >/=9 degrees C in a refrigerator or >/=-14 degrees C (recommended for varicella vaccine) in freezer, and odds ratios (ORs) for risk factors associated with outcomes. We performed chi(2) analysis and Student's t tests to compare the administrative characteristics and quality assurance practices of offices with optimal vaccine storage with those with suboptimal storage, and to compare the proportion of offices with suboptimal storage practices in the groups that did and did not receive the CDC manual. RESULTS: Statewide estimates of offices with at least 1 type of suboptimal vaccine storage included: freezer temperatures measuring >/=-14 degrees C = 17% (95% CI: 10.98, 23.06); offices with refrigerator temperatures >/=9 degrees C = 4.5% (95% CI: 1.08, 7.86); offices with expired vaccines = 9% (95% CI: 4.51, 13.37); and offices with at least 1 documented storage problem, 44% (95% CI: 35.79, 51.23). Major risk factors associated with vaccine storage outside recommended temperature ranges were: lack of thermometer in freezer (OR: 7.15; 95% CI: 3.46, 14.60); use of freezer compartment in small cold storage units (OR: 5.46; 95% CI = 2.70, 10.99); lack of thermometer in refrigerator (OR: 3.07; 95% CI: 1.15,8.20); and failure to maintain temperature log of freezer (OR: 2.70; 95% CI: 1.40, 5.23). Offices that adhered to daily temperature monitoring for all vaccine cold storage compartments, compared with those that did not, were 2 to 3 times more likely to assign this task to staff with higher levels of training, have received a recent visit from the state immunization program, and be affiliated with a hospital or have Federally Qualified Health Center status. In addition, sites using >1 refrigerator/freezer for vaccine storage were more likely to have at least 1 cold storage compartment outside recommended temperature ranges. We found no significant differences in the data reported above between the intervention group (received copy of the draft manual) and the control group (did not receive copy of draft manual), even when controlling for the annual number of immunizations given or the type of office. (ABSTRACT TRUNCATED)

Child↗
PubMed2003

Immunologic analysis of blood samples obtained from horses and stored for twenty-four hours.

OBJECTIVE: To determine whether immune function can be accurately assessed in blood samples obtained from horses and refrigerated overnight and whether a nonradioactive lymphocyte proliferation assay can be used to evaluate samples obtained from horses. SAMPLE POPULATION: 224 blood samples from 28 clinically normal adult horses. PROCEDURE: Heparinized blood samples were collected. Each sample was divided into 2 equal aliquots. One aliquot was refrigerated overnight to simulate overnight shipping of blood samples, and the other aliquot was evaluated on the day of blood collection. Lymphocytes were isolated and enumerated by use of a modified single-gradient procedure. Cell viability and function were assessed by use of cytologic examination, flow cytometry, and mitogen-induced proliferation assays. Lymphocyte proliferation in response to T- and B-cell mitogens was measured by use of [3H]-thymidine incorporation and a nonradioactive lymphocyte proliferation assay. RESULTS: Lymphocytes refrigerated for up to 24 hours continued to be acceptable for use in immunologic analysis on the basis that they maintained viability and did not have significant alterations in lymphocyte subsets, except for CD8, when compared with freshly isolated lymphocytes. Furthermore, results for mitogen-induced lymphocyte proliferation assays were also comparable between fresh and refrigerated aliquots. CONDUSIONS AND CLINICAL RELEVANCE: The nonradioactive lymphocyte proliferation assay is a reliable alternative to [3H]-thymidine assay for assessing proliferation of equine lymphocytes. Collectively, our results imply that blood samples refrigerated and shipped ovenight to a laboratory can be used to perform cellular-immune assays; results of those assays would enhance a clinician's diagnostic abilities to monitor the efficacy of treatment.

Animals↗
PubMed1997

Timeliness of urinalysis: a College of American Pathologists Q-probes study of 346 small hospitals.

OBJECTIVE: To explore preanalytic handling of urinalysis specimens. DESIGN: The study was a College of American Pathologists Q-Probes study consisting of two parts. The first part was a questionnaire about participants' urinalysis practices. The second part required collection of information from four specific urinalysis specimens per shift on 30 consecutive days or from 200 urine specimens, whichever occurred first. SETTING: Three hundred forty-six small hospitals enrolled in the Small Hospital Q-Probes program. MAIN OUTCOME MEASURES: Compliance with guidelines requiring nonrefrigeration and specimen measurement within 2 hours of collection, and identification of practices associated with better performance. RESULTS: Almost 50,000 urinalysis specimens were analyzed. About 68% of the specimens were measured without prior refrigeration, 2.3% were refrigerated before, 17.9% were refrigerated after, and 4.5% were refrigerated before and after arrival in the laboratory. Aggregate analysis indicated that 11.2% of never-refrigerated specimens exceeded the recommended 2-hour time standard before analysis. For inpatients and outpatients, respectively, 64% and 77% of laboratories were able to meet the 2-hour goal 90% of the time. Improved performance was associated statistically with ordering urinalysis stat, an enforced policy of specimen rejection for delayed transport of inpatient specimens, and the listing of a collection time for outpatient specimens. CONCLUSIONS: A large number of urinalysis specimens exceeded current quality guidelines for handling. Laboratories must monitor and improve preanalytic handling of urinalysis specimens.

Hospital Bed Capacity, 100 to 299↗
PubMed1988

Effect of storage temperature of insulin on pharmacokinetics and pharmacodynamics of insulin mixtures injected subcutaneously in subjects with type 1 (insulin-dependent) diabetes mellitus.

These studies were undertaken to assess the influence of storage temperature of insulin vials on pharmacokinetics and pharmacodynamics of a mixture of lente insulin (Monotard HM) and regular insulin (Actrapid HM) injected subcutaneously. Seven subjects with Type 1 (insulin-dependent) diabetes mellitus were studied twice after overnight normalization of plasma glucose. A mixture of lente insulin (0.22 U/kg) and regular insulin (0.11 U/kg) was prepared from insulin vials kept either refrigerated (approximately 4 degrees C) or at room temperature (approximately 18 degrees C) and injected subcutaneously (abdomen). Euglycaemia was maintained for the following 16 h by glucose infusion at variable rate. With refrigerated insulin, the plasma free insulin peak was greater (53 +/- 5 versus 45 +/- 6 mU/l) and occurred earlier (2.5 +/- 0.2 versus 6 +/- 0.3 h), and the glucose infusion rate showed a greater (16.5 +/- 1.2 versus 14.5 +/- 0.9 mumol.kg-1.min-1) and earlier peak (3.2 +/- 0.2 versus 6 +/- 0.4 h) as compared to that occurring with the non-refrigerated insulin (p less than 0.05). However, 6 h after insulin injection, both plasma free insulin and glucose infusion rate were 30% lower with the mixture of refrigerated as compared to that of non-refrigerated insulin (p less than 0.05). In contrast, when NPH-insulin (Protaphane HM) was mixed with regular insulin and injected in 4 out of the 7 diabetic patients, the storage temperature of insulin vials had no effect on the pharmacokinetics and pharmacodynamics of the mixture.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗