Manual para otimização da aquisição de medicamentos no âmbito hospitalar / Manual for optimizing the acquisition of medicines in the hospital environment

Introdução: a falta de um medicamento durante a internação hospitalar, põe em risco o correto cumprimento dos planos terapêuticos traçados para os pacientes, o que pode vir a gerar a recidiva de um quadro clínico, o prolongamento do tempo de internação e o consequente aumento de custos para a instituição, seja ela pública ou privada. Dentro da cadeia logística do medicamento, diversas são as etapas que podem contribuir para o desabastecimento. No âmbito hospitalar essa logística se dá por meio do ciclo da assistência farmacêutica que compreende as etapas de seleção, programação, aquisição, armazenamento, distribuição e dispensação de medicamentos. Os estoques da farmácia hospitalar são caracterizados por ciclos de demandas e de ressuprimentos, com flutuações significativas, o que dificulta a disponibilidade na mesma proporção da utilização do medicamento. Tendo em vista esta complexidade torna-se necessário o uso de indicadores, que avaliem os processos de trabalho. Objetivos: o objetivo deste estudo foi identificar as principais causas de desabastecimento de medicamentos em uma unidade de saúde e desenvolver um manual para otimização da aquisição de medicamentos. Materiais e método: Inicialmente foi realizado um mapeamento do fluxo de valor a fim de compreender a movimentação de materiais e informações envolvidos no processo de aquisição de medicamentos. Posteriormente, confeccionou-se uma planilha para registrar o fluxo logístico dos produtos, que resultou na obtenção dos pontos críticos do processo. A coleta dos dados de aquisição de medicamentos foi realizada durante o ano de 2019. Os critérios avaliados foram definidos com base nas ocorrências que mais contribuíram para o desabastecimento, seja pela relevância, ou pela frequência. Por fim foi elaborado um manual contendo critérios, normas, e procedimentos, a serem seguidos a fim de se evitar o desabastecimento. Resultados: Elaboração de um manual para otimização da aquisição de medicamentos composto por: mapa do fluxo de valor logístico de medicamentos, planilha para registro da logística de aquisição de medicamentos, procedimentos operacionais padrão para a gestão da aquisição de medicamentos. Conclusão: com o manual espera-se otimizar a gestão logística de medicamentos e reduzir a incidência de problemas com desabastecimento, gerando um impacto positivo na assistência ao paciente

Introduction: the lack of a drug during hospitalization puts at risk the correct compliance with the therapeutic plans outlined for the patients, which can lead to the recurrence of a clinical condition, the extension of the hospital stay and the consequent increase in costs for the institution, whether public or private. Within the drug's logistics chain, there are several steps that can contribute to shortages. In the hospital context, this logistics takes place through the pharmaceutical care cycle, which comprises the stages of selection, programming, acquisition, storage, distribution and dispensing of medicines. Hospital pharmacy stocks are characterized by cycles of demand and resupply, with significant fluctuations, which makes availability in the same proportion as the use of the medication difficult. Due to this complexity, it is necessary to use indicators that assess work processes. Objectives: The aim of this study was to identify the main causes of drug shortages in a health unit and to develop a manual for optimizing drug acquisition. Materials and method: Initially, a mapping of the value stream was carried out in order to understand the flow of materials and information involved in the drug procurement process. Subsequently, a spreadsheet was made to record the logistical flow of the products, which resulted in the critical points of the process being obtained. Logistic data for drug acquisition during 2019 were collected and the criteria evaluated were defined based on the occurrences that most contributed to the shortage, either by relevance or by the frequency with which they occurred. Finally, a manual was created containing criteria, norms, and procedures to be followed in order to avoid shortages. Results: Preparation of a manual for optimizing drug procurement, comprising: a map of the logistical value flow of drugs, a spreadsheet for recording the logistics of drug procurement, standard operating procedures for managing drug procurement. Conclusion: the manual is expected to optimize the logistical management of medicines and reduce the incidence of problems with shortages, generating a positive impact on patient care

Estoque e descarte de medicamentos no domicílio: uma revisão sistemática / Storage and disposal of pharmaceuticals at home: a systematic review

Resumo Este estudo teve como objetivo analisar a evidência científica nacional e internacional existente sobre o motivo do estoque e a forma de descarte dos medicamentos no domicílio. Realizou-se uma revisão sistemática da literatura de 2001 a 2016 nas bases de dados PubMed, Lilacs e Elsevier's Scopus Database, utilizando os seguintes unitermos: "Disposal of medicines in household", "Disposal of expired drugs", "Residential expired drugs", "Management of expired medications in household". Foram selecionados 33 estudos originais após aplicação dos critérios de inclusão e exclusão. Os estudos analisados demonstraram que os principais motivos de estoque no domicílio foram: automedicação; guarda para uso futuro e sobras de tratamentos anteriores. E quanto ao descarte dos medicamentos, prevalecem práticas inadequadas, como descarte no lixo comum e na rede de esgoto. Alguns países têm adotado programas de orientação sobre o armazenamento e o descarte correto, no entanto, foi apenas encontrado um estudo que descreve um programa nacional gratuito, para orientar essas práticas. A partir das evidências cientificas verificou-se a importância do incentivo para a elaboração e a implementação de políticas públicas voltadas para o uso e descarte adequado de medicamentos no domicílio.

Abstract This study's objective was to analyze Brazilian and international scientific evidence on the reasons people store medication at home and the disposal methods used. This systematic literature review includes studies published from 2001 to 2016 and indexed in PubMed, Lilacs and Elsevier's Scopus Database, using the following key words: Disposal of medicines in household, Disposal of drugs expired, Residential expired drugs, Management of expired medications in household. Thirty-three studies were selected after applying inclusion and exclusion criteria. The studies reveal that the main reasons people keep a stock of medicines at home include the possibility of future use, leftovers from previous treatments, and self-medication. Inappropriate disposal methods prevail, such as throwing medicines in the household trash or flushing them into the sewer. Some countries have adopted programs to educate on proper storage and disposal of medicines, though only one study describes a national program guiding these practices that is free of charge. Evidence shows there is a need to implement public policies intended to provide guidance on the proper storage and disposal of medicines at home.

Estabilidad de la vacuna Candid#1 para prevenir la fiebre hemorrágica Argentina / Stability of Candid#1 vaccine to prevent Argentine Hemorrhagic Fever

Candid#1 es la primera vacuna a virus vivo atenuado producida y registrada en Argentina. Se produce en el INEVH desde 2003 para prevenir la fiebre hemorrágica argentina y se obtiene mediante cosecha de sobrenadantes de cultivos de células diploides infectadas con una cepa atenuada del virus Junín, formulación y posterior liofilización. Su estabilidad es crucial para asegurar su efectividad. El objetivo de este trabajo fue evaluar la estabilidad de Candid#1 exponiéndola a distintas condiciones de temperatura y tiempo. Tres lotes producidos en 2003 fueron sometidos al siguiente esquema de almacenamiento: (a) vacuna reconstituida conservada entre 2 °C y 8 °C durante 8 días, (b) vacuna liofilizada conservada entre 2 °C y 8 °C durante 6 meses, y (c) vacuna liofilizada conservada entre -18 °C y -20 °C durante 10 años. La potencia fue evaluada en monocapa de células Vero bajo agar. Los resultados fueron: (a) Candid#1 reconstituida fue estable 8 días entre 2 °C y 8 °C, (b) Candid#1 liofilizada fue estable 2 meses entre 2 °C y 8 °C y (c) Candid#1 liofilizada fue estable 9 años entre -18 °C y -20 °C manteniendo todos sus atributos. Estos resultados permitieron establecer las siguientes condiciones de almacenamiento: reconstituida 12 horas entre 2 °C y 8 °C, liofilizada 30 días entre 2 °C y 8 °C y 9 años entre -18 °C y -20 °C. A la luz de estos resultados, se generaron cambios favorables en las condiciones de transporte, almacenamiento y distribución de la vacuna. Se implementó la instalación de freezers domésticos en centros estratégicamente distribuidos, permitiendo preservar stocks de vacuna y distribuir las dosis necesarias a vacunatorios.

Candid#1 is the first live attenuated vaccine produced and registered in Argentina. Produced since 2003 at the INEVH to prevent Argentine hemorrhagic fever, it is obtained by harvesting supernatants of diploid cells infected with an attenuated strain of Junin virus and subsequent lyophilization. The stability of this vaccine is crucial to ensure its effectiveness. This study was aimed to evaluate the stability of Candid#1 by exposing it to different time and temperature conditions. Three vaccine batches produced in 2003 were analysed according to the following storage scheme: (a) reconstituted vaccine at 2 °C to 8°C for 8 days; (b) lyophilized vaccine at 2 °C to 8 °C for 6 months; (c) lyophilized vaccine at -18 °C to -20 °C for 10 years. The potency was assessed in Vero cell monolayers under agar. The results were: (a) reconstituted vaccine was stable between 2 °C and 8 °C for 8 days, (b) lyophilized vaccine was stable between 2 °C and 8 °C for 2 months, and (c) lyophilized vaccine was stable 9 years between -18 °C and -20 °C, keeping all its properties. These results allowed us to establish the following storage conditions and expiration times for Candid#1: (a) reconstituted: 12 hours between 2 °C and 8 °C, (b) lyophilized: 30 days between 2 °C and 8 °C and (c) lyophilized: 9 years between -18 °C and -20 °C. Based on our results, favorable changes were made in the conditions of transport, storage and distribution of the vaccine. Domestic freezers in strategically located centers were installed, allowing the preservation of vaccine stocks for distribution to secondary vaccination centers.

Organizadores e cortadores de comprimidos: riscos e restrições ao uso / Pill organizers and pill cutters: risks and limitations / Organizadores y cortadores de comprimidos: riesgos y restricciones del uso

Com base em análise documental, foram discutidas e problematizadas as limitações associadas à utilização de organizadores e cortadores de comprimidos, como questão de saúde pública. Os organizadores destinados ao armazenamento e transporte de comprimidos e cápsulas expõem essas formas farmacêuticas a fatores ambientais dos quais estariam protegidos em suas embalagens originais, comprometendo sua estabilidade, eficácia e segurança. Os cortadores oferecem risco adicional quanto a perda da eficácia, reações adversas e intoxicação. Por outro lado, o transporte de medicamentos pelo usuário é reflexo da conciliação entre autonomia e autocuidado e a partição de comprimidos é necessária para cumprir certos regimes posológicos. Conclui-se que cabe aos profissionais observar e orientar pacientes e cuidadores, visando à adequação dessas condutas e à prevenção dos riscos envolvidos.

In this essay, based on documental analysis, the limitations associated with the use of pill organizers and cutters are discussed and analyzed as a matter of public health. The use of the organizers for storing and carrying tablets and capsules exposes these medications to environmental factors from which their original packaging protected them, compromising their stability and safeness. Cutters also pose the additional risk of causing loss of efficacy, adverse reactions and overdose. On the other hand, the user carrying their own medication reflects the balance between autonomy and self-care, and splitting is sometimes required to comply with certain regimens. It can be concluded that healthcare professionals should observe and guide patients and caregivers in order to avoid risks.

Objetivo Con base en análisis documental, se discutieron y señalaron los problemas de las limitaciones asociadas a la utilización de organizadores y cortadores de comprimidos, con respecto a la salud pública. Los organizadores destinados al almacenamiento y transporte de comprimidos y cápsulas exponen las formas farmacéuticas a factores ambientales de los cuales estarían protegidos en sus embalajes originales, comprometiendo su estabilidad, eficacia y seguridad. Los cortadores ofrecen riesgo adicional con relación a la pérdida de la eficacia, reacciones adversas e intoxicación. Por otro lado, el transporte de medicamentos por el usuario es reflejo de la conciliación entre autonomía y autocuidado, y la partición de comprimidos es necesaria para cumplir ciertos regímenes posológicos. Se concluye que resta a los profesionales observar y orientar pacientes y cuidadores, buscando la adecuación de esas conductas y la prevención de los riesgos involucrados.

Nursing Care and Patient Safety: Visualizing Medication Organization, Storage and Distribution with Photographic Research Methods / Cuidados de enfermagem e segurança do paciente: visualizando a organização, acondicionamento e distribuição de medicamentos com método de pesquisa fotográfica / Cuidado de enfermería y seguridad del paciente: visualizando la organización, acondicionamiento y distribución de medicamentos con método de investigación fotográfica

In this qualitative study, we adapted photographic research methods from earlier nursing research to identify factors related to organization, storage and distribution that could lead to errors in the selection, preparation and administration of medications. The research excerpt presented here was developed in a clinical unit of an urban Brazilian public hospital. The research participants were nurses working at that unit and students from the two final semesters of the Undergraduate Nursing Course. We collected digital photographs of the medication system and subsequently used photo elicitation to review the images with research participants, so as to obtain their perceptions and narratives of working with medications in the unit. We report selected findings here on the organization, storage and distribution of medications, which indicate there is room to improve the safety of the medication system.

Neste estudo qualitativo, adaptou-se o método de pesquisa fotográfica de estudos anteriores, para identificar fatores relacionados à organização, acondicionamento e distribuição que poderiam levar a erros na seleção, preparo e administração de medicamentos. O recorte da pesquisa apresentado foi desenvolvido em unidade de clínica médica de um hospital público, Brasil. Os participantes da pesquisa foram enfermeiros que trabalhavam naquela unidade e acadêmicos dos dois últimos semestres do curso de graduação em Enfermagem. Obtiveram-se fotografias digitais do sistema de medicação e, subsequentemente, utilizou-se a elicitação das fotos para rever imagens com os participantes da pesquisa, a fim de obter suas percepções e narrativas a respeito do trabalho com medicamentos, naquela unidade. Apresenta-se uma seleção dos principais achados da pesquisa sobre organização, acondicionamento e distribuição de medicamentos, indicando que há espaço para melhorar a segurança do sistema de medicação.

En este estudio cualitativo, se adoptó el método de investigación fotográfica de estudios anteriores, para identificar factores relacionados a la organización, acondicionamiento y distribución, los que podrían conducir a errores en la selección, preparación y administración de medicamentos. Esta parte de la investigación que se presenta fue desarrollada en una unidad de clínica médica de un Hospital Público, en Brasil. Los participantes de la investigación fueron enfermeros que trabajaban en aquella unidad y estudiantes de los dos últimos semestres del Curso de Graduación en Enfermería. Fueron obtenidas fotografías digitales del sistema de medicación y subsecuentemente, se obtuvieron las fotos para analizar las imágenes con los participantes de la investigación, a fin de obtener sus percepciones y narrativas al respecto del trabajo con medicamentos en aquella unidad. Se presenta una selección de los principales hallazgos de la investigación sobre organización, acondicionamiento y distribución de medicamentos, indicando que hay espacio para mejorar la seguridad del sistema de medicación.

Trends of home drug storage and use in different regions across the northern United Arab Emirates

To investigate the habits of use and home storage of over-the-counter [OTC] and prescription drugs. A pretested questionnaire was distributed to university students who represented 300 household units in different regions of the northern United Arab Emirates. Household chairs [parents] answered questions on various aspects of home use and storage of OTC and prescription medicines. The number of drugs stored at home was collapsed into 5 unequal groups [1-3, 4-6, 7-10, 11-15 and 16-20]. The response rate was 300 [100%]. The average number of drugs per household unit was 6 items. Almost 40% of the participants stored between 16 and 20 drugs. More than half [56%] of the household units stored medicines in a home pharmacy kept either in the bedroom [n=66; 39%] or in the kitchen [n=71; 42%]. No correlation was found between the level of education and the number of family members [r=0.29] or drugs stored at home [r=-0.35]. Only 2 [0.7%] of the participants did not keep drugs at home. There was a clear discrepancy in either OTC or prescription drugs stored, and the variation in the utilization and preference of drugs was obvious among the pooled sample. Various problems related to the use and storage at home of OTC and prescription drugs were revealed. Discussing the results of this survey with students who participated as members of the household units that took part in the study may prove to be a helpful intervention. The need for public educational efforts on the rational use of medicines at home is urgent to foster awareness of the proper use of drugs

Microhardness of glass ionomer cements indicated for the ART technique according to surface protection treatment and storage time

The aim of this study was to assess the microhardness of 5 glass ionomer cements (GIC) - Vidrion R (V, SS White), Fuji IX (F, GC Corp.), Magic Glass ART (MG, Vigodent), Maxxion R (MR, FGM) and ChemFlex (CF, Dentsply) - in the presence or absence of a surface protection treatment, and after different storage periods. For each GIC, 36 test specimens were made, divided into 3 groups according to the surface protection treatment applied - no protection, varnish or nail varnish. The specimens were stored in distilled water for 24 h, 7 and 30 days and the microhardness tests were performed at these times. The data obtained were submitted to the ANOVA for repeated measures and Tukey tests (á = 5 percent). The results revealed that the mean microhardness values of the GICs were, in decreasing order, as follows: F > CF = MR > MG > V; that surface protection was significant for MR, at 24 h, without protection (64.2 ± 3.6a), protected with GIC varnish (59.6 ± 3.4b) and protected with nail varnish (62.7 ± 2.8ab); for F, at 7 days, without protection (97.8 ± 3.7ab), protected with varnish (95.9 ± 3.2b) and protected with nail varnish (100.8 ± 3.4a); and at 30 days, for F, without protection (98.8 ± 2.6b), protected with varnish (103.3 ± 4.4a) and protected with nail varnish (101 ± 4.1ab) and, for V, without protection (46 ± 1.3b), protected with varnish (49.6 ± 1.7ab) and protected with nail varnish (51.1 ± 2.6a). The increase in storage time produced an increase in microhardness. It was concluded that the different GICs, surface protection treatments and storage times could alter the microhardness values.

Studies on the effect of temperature treatment and storage of crude plant extracts on antibacterial activity

Present paper deals with the effect of temperature treatment and storage of 15 days at 4°C of plant extracts on antibacterial activity. Crude extracts of Ficus religiosa, Adhatoda vasica and Ephedra foliata were evaluated in above mentioned conditions against certain bacterial text organisms i.e. Staphylococcus aureus, Bacillus subtilis, Bacillus megaterium [Gram positive] and Escherichia coll, Salmonella typhi, Proteus vulgaris, Shigella dysenterieae, Shigella flexneri [Gram negative]. During this investigation any variant behaviour of temperature treated extract has been recorded. In general, a declined [reduced] trend of antibacterial activity was recorded and complete loss of drug efficacy was also noted against S. typhi in treated extract of F religiosa. Antibacterial activity remained as such against certain bacterial text organisms indicate the thermostable nature of specific components of the treated extract activity against specific bacterial species. 15 days storage of bark extract of F. religiosa at 4°C has yielded enhanced activity in aqueous extract of F. religiosa against B. megaterium, Shigella dysenterieae and in alcoholic extract against B. megaterium. Similarly storage extract of E. foliata also showed enhanced antibacterial activity against B. megaterium

Effect of storage temperature on the stability of chemical and physical properties of profenofos insecticide formulation [EC]

Profenofos insecticide was subjected to different storage conditions at the temperatures 54°C for 14 days, zero °C for 7 days according to FAO specifications [1998] and, in sunny place and in dark place for 360 days according to Egyptian conditions. Chemical stability of profenofos was stable if stored either at 54 °C or zero °C for 14 and 7 days, respectively conformed with Food and Agriculture Organization [FAO] specifications during periods of storage and more degradated in sunny place than in dark place. Physical properties [pH range, Emulsion stability and re-emulsification] became conformity with FAO specification

Treatment of invasive fungal infections: stability of voriconazole infusion solutions in PVC bags

Voriconazole is a novel broad-spectrum antifungal drug, employed in the treatment of invasive fungal infections, and represents an alternative to amphotericin B treatment. The manufacturer recommends that any unused reconstituted product should be stored at 2ºC to 8ºC, for no more than 24 h, but no recommendations about i.v. infusion solutions are given. Previous works have reported on the stability of voriconazole in polyolefin bags and just one in 5 percent dextrose polyvinyl chloride (PVC) bags, at a 4 mg.mL-1 concentration. In this work, the stability of voriconazole as an i.v. infusion solution in 0.9 percent sodium chloride and in 5 percent dextrose, in PVC bags, at 0.5 mg.mL-1, stored at 4 ºC and at room temperature, protected from light, was evaluated. These infusion solutions were analyzed for a 21-day period. Chemical stability was evaluated by HPLC assay. Visual inspection was performed and pH of the solutions was measured. No color change or precipitation in the solutions was observed. The drug content remained above 90 percent for 11 days in 0.9 percent sodium chloride and for 9 days in 5 percent dextrose solutions. The i.v. infusion solutions stored at room temperature were not stable. At room temperature, the voriconazole content dropped down to 88.3 and 86.6 percent, in 0.9 percent sodium chloride or 5 percent dextrose solutions, respectively, two days after admixture. Assays performed at the end of the study suggest the sorption of voriconazole by the PVC bags. The results of this study allow cost-effective batch production in the hospital pharmacy.

Enfermagem e segurança na terapia medicamentosa em unidades intensivas / Nursing and safety in medicine care in intensive units

Esse estudo tem como temática o manejo da terapia medicamentosa pela enfermagem sob a ótica da segurança dos pacientes em terapia intensiva. O problema de pesquisa foi: existem erros e/ou situações que favoreçam a ocorrência de erros nas etapas de armazenamento, local de preparo, preparo e administração de medicamentos por parte da equipe de enfermagem na terapia intensiva? Os objetivos foram: a) identificar as situações consideradas como facilitadoras do erro nas etapas de armazenamento, local de preparo, preparo e administração de medicamentos na terapia intensiva; b) analisar as ocorrências de erros nas etapas de armazenamento, local de preparo, preparo e administração de medicamentos, associadas ao trabalho da equipe de enfermagem na terapia intensiva. Esse trabalho justificou-se pela enfermagem assumir, dentro da perspectiva do manejo da terapia medicamentosa, a busca da qualidade na assistência, traduzida por uma prática segura, livre de riscos, permitindo o pronto restabelecimento do paciente. Os referenciais teóricos utilizados foram sistema de medicação e erro em medicação. Trata-se de um estudo exploratório, observacional, com abordagem quantitativa realizado no Hospital Pró-Cardíaco em três UTIs: Unidade Coronariana (UCOR), UTI de Pós-Operatório (UPO) e Unidade de Terapia Intensiva Geral (UTI). A população foi composta por 45 enfermeiros e 44 técnicos de enfermagem observados no preparo e administração de uma medicação...

The purpose of this study is the medicine care management by the nursing in the patients safety view in intensive care. The research issue was: Are there any mistakes and/or situations which can help the mistakes occurrence over the storage stages, the place of preparation, the preparation and the medicine dispensing by the nursing staff in the intensive care? The objective were: a) to identify the situation which facilitated the mistakes in the storage stages, the place of preparation, the preparation and the medicine dispensing in the intensive care; b) to analyze the mistakes occurrence over the storage stages, the place of preparation, the preparation and the medicine dispensing associated to the nursing staff in the intensive care. This work justified itself by the nursing assume, in the management view of the medicine therapy, the search for the quality in care, translated into a safe practice, allowing the quick recovery of the patient. The theoretical reference were a medicine and a mistake of medicine system. Study exploratory, observational, with quantitative approach undertaken in the Pro - Cardiac Hospital in three ICUs: Coronary Unit (UCOR), ICU, Post-Operative (UPO) and General intensive care units (ICU). Population: 45 nurses and 44 technical nursing observed in the preparation and the dispensing of the medication...

The key role of vaccine vial monitors in routine and mass immunisation.

The vaccine vial monitor is an excellent monitoring device to assure that only non-heat damaged vaccine is administered to women and children. They help to extend access to immunisation, they increase the efficiency and reduce wastage in the cold-chain and, when visible on all vaccine vials of all types, they will help to streamline distribution systems for immunisation services of the 21st century in all developing countries.

Determinação dos pontos críticos no processo de importação de produtos termolábeisDeterminação dosp ontos críticos no processo de importação de produtos termolábeis / Critical points determination in the process of temperature sensitive products importation

Produtos sensíveis à temperatura estão sujeitos ao Controle Sanitário cujas ações consistem na inspeção de produtos importados em portos, aeroportos e fronteiras. Objetivo: Determinar os pontos críticos durante o processo de importação de produtos termolábeis, identificando seu fluxo da carga, com base no processo documental e operacional da importação de produtos sujeitos ao Controle Sanitário. Método: estudo descritivo utilizando observação sistemátizada de 36 armazéns alfandegados do estado de São Paulo, relativo à: localização, estrutura física, meios de transporte utilizados, segregação de produtos, equipamentos de refrigeração, monitoramento da temperatura, além de pesquisa sistematizada de documentos, legislação e dados estatísticos de organismos oficiais nacionais e internacionais. Resultados: foi observado que a importação de produtos termolábeis pode ser efetuada em diferentes modalidades, utilizando um ou mais meios de transporte; os armazéns alfandegados estão localizados de forma estratégica para assegurar o acesso e a distribuição dos produtos. Em 2003, foram registradas no Brasil temperaturas extremas de 40ºC positivos e 4ºC negativos. Os armazéns alfandegados possuem capacidades instaladas de refrigeração diferentes entre si, cujo monitoramento da temperatura se dá de forma diveresa e. algumas vezes precária. Diferentes grupos de produtos podem representar diferentes fontes de risco dependendo da exposição a condições ambientais adversas. Conclusões: Dos pontos críticos identificados no processo de importação de produtos sensíveis à temperatura destacam-se: não familiaridade com os documentos e fluxo operacional, preenchimento inapropriado dos documentos de importação, unitilização da carga, modos e meios de trasnporte e seu percurso, embalagem, viabilidade e capacidade de armazenamento, qualidade do serviço de refrigeração prestado

Vaccine storage conditions in clinics in Colombo.

OBJECTIVES: To study the practices of health personnel regarding vaccine storage and the integrity of the cold chain, during storage, in immunisation clinics. DESIGN: A cross-sectional descriptive survey based on a postal questionnaire and an observational study of the cold chain during storage of a randomly selected sample. SETTING: Colombo District. PARTICIPANTS: 10 health centres, 13 Colombo Municipal Council Clinics, 26 general practices receiving vaccines from health centres, 13 private hospitals and 10 state-run hospitals. METHOD: A pretested postal questionnaire collected information on storage conditions and compliance with EPI requirements. The sub-sample in which the temperatures were monitored consisted of 33% of the total. The study was carried out in 1995-1996, when there was an uninterrupted power supply. OUTCOME MEASURES: Responses to the postal questionnaires and the colour changes recorded in thermosensitive WHO cold chain monitors. RESULTS: The response rate to the postal questionnaire was 87.5%. All 63 respondents stored vaccines in refrigerators worked by electricity. Information regarding refrigerators showed 46% to be less than 5 years old and 17% were more than 15 years old. 97% of refrigerators had good door seals. Regular defrosting was claimed by 79% of clinics and 81% had a named person responsible for vaccine storage. Only 57% had thermometers available and temperatures were monitored daily in only 40% of clinics. 76% of refrigerators were used for purposes other than storage of vaccines. Colour changes were noted in 2 out of 22 cold chain monitors.