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A cold chain is a series of climate-controlled transport and storage facilities that ensure the viability of testing reagents, medicines, vaccines, and blood products from factory to patient.
Medical refrigerators are used to store many health-care supplies: blood products, vaccines, medicine, and testing reagents. Each has a slightly different chilling requirement. Vaccines are sensitive to both heat and cold and so need to be kept between 2°C and 8°C from the point of manufacture to the point of use. In order to properly store blood and blood products, blood bank refrigerators need to keep internal temperatures between 2°C and 6°C all day, every day. Some vaccines need to stay frozen, so medical freezers must maintain internal temperatures between -15°C and -50°C . The lack of access to electricity or intermittent power supply in many remote health-care facilities complicate the storage of these critical medical supplies. In many developing countries, reliable power is rare. Access to grid power, especially for rural facilities, simply may not be available. This lack of power, or lack of steady power, jeopardizes the ability of blood banks to safely store blood.
It is important to understand the continuous electricity demand of refrigeration when designing an energy system for a health-care facility with an internal blood bank or lab. The table below shows the energy requirements of a sample blood bank in Haiti, but it is representative of the loads found in blood banks within typical health-care facilities.
| Area | Quantity | Load (Watts) | Operation Time (Hours) | Daily Energy (Watt-hours) | Total Power (Watts) |
|---|---|---|---|---|---|
| Lighting | |||||
| Fluorescent Lamps | 4 | 40 | 8 | 1,280 | 160 |
| Total Lighting | 3,560 | 1,260 | |||
| Equipment | |||||
| Heaters | 2 | 100 | 4 | 800 | 200 |
| Microscope | 2 | 30 | 6 | 360 | 60 |
| Centrifuge | 2 | 400 | 2 | 1,600 | 800 |
| TV | 1 | 200 | 4 | 800 | 200 |
| Total Equipment | 3,560 | 1,260 | |||
| Refrigeration | |||||
| Staff Refrigerator | 1 | 50 | 24 | 240 | 50 |
| Blood Bank Refrigerator | 1 | 667 | 24 | 3,200 | 667 |
| Backup Refrigerator | 1 | 70 | 24 | 336 | 70 |
| Total Refrigeration | 3,776 | 787 | |||
| Grand Total | 8,616 | 2,707 | |||
As the example blood bank load chart illustrates, refrigeration and lab equipment have comparable energy demands. When choosing a refrigerator for blood, vaccine, or reagent cold storage, facility managers should consider numerous specifications that affect the cost of operation and temperature stability. These specifications include capacity, energy use, approved refrigerator use, ambient temperature ratings, power source, holdover time, reliability, price, required training, and refrigerant selection. Care should be taken to ensure that energy-efficient, properly sized refrigerators are used for each facility.
Different refrigeration technologies have been developed to extend the cold chain to remote areas, including 12 volt electric, liquefied petroleum gas (LPG), and kerosene-powered models. Gas/electric hybrid refrigerators should be considered for facilities with intermittent power supplies.
Temperature monitoring is a crucial part of the cold chain. There are many methods that have been developed to monitor temperature during the transport and storage of medical products.
Before investing in any energy technologies, a health facility must first understand its current day-to-day energy requirements. An initial energy audit is critical to ensuring proper system design and operation. Learn more
The World Health Organization (WHO) provides specifications for different categories of refrigerators and freezers used by health-care facilities. It also lists the products that comply with these specifications. View the standards
This publication aims to provide basic information on the blood cold chain and guidelines for its management. View the resource
This resource provides general information on the choice of equipment, together with specific technical and purchasing data for certain items. View the resource
