Knowledge of health care workers regarding cold chain in EPI program at governmental and private health facilities in Riyadh and Eastern regions, Saudi Arabia, 2004.
Immunization is an important means of controlling infectious diseases. Careful attention to vaccine storage is essential to ensure optimal vaccine effectiveness. The system used for keeping and distributing vaccines in good condition is called the cold chain. This consists of a series of storage and transport links, designed to keep the vaccine at the correct temperature until it reaches the user. This study was conducted to evaluate the knowledge of health workers in the Extended Program of Immunization (EPI) about cold chain, at a sample of governmental and private health facilities in Riyadh and Eastern region.
Methodology
A cross sectional study was conducted in a sample of 60 governmental primary health centers and private dispensaries. A questionnaire was designed to evaluate cold chain components in each health center and to collect specific information from health workers. It included workers' demographic information, and questions evaluating their knowledge about the vaccine cold chain equipment, the vaccine itself, cold chain maintenance, and whether they had participated in training on cold chain maintenance. A cumulative score for assessment of Knowledge was developed based on the 75 questions asked and used for further analysis of association between exposure and outcome. In the absence of any standard criteria of scoring for such knowledge questions, the median score of 55.5 was used as a cut off point to split the workers into two categories: low knowledge group (score of 15-55) and high knowledge group (score of 56-72).
Results
In Riyadh city: 37 health facilities were included, 22 governmental (GHF) and 15 Private (PHF). All workers in vaccination clinics of these health facilities were females, of whom 72.7% were Saudi and 27.3% non Saudi in GHF, compared to 13.3% Saudi and 76.7% non-Saudi in PHF. Correct responses of total workers were as follows: regarding place of refrigerator inside the vaccination room, only 22.7% of GHWs and 13.3% of PHW; time of defrosting none of GHW and only 6.7% PHW; knowledge of place of vaccine during defrosting 72.8% of GHW and 80% of PHW; availability of water bottles in refrigerator all GHWs (100%) and 60% of PHW, among them, all GHWs correctly responded regarding place of water bottles inside refrigerator compared to 88.9% of PHWs. Regarding placement of regular thermometer inside refrigerator, 86.4% of GHWs answered correctly compared to 53.3% of PHW; time of changing the temperature chart 86.4% GHWs compared to 40% of PHWs; time of recording the temperature of refrigerator all GHWs (100%) compared to only 33.3% of PHWs; and regarding the space between vaccine vials all GHW (100%) responded correctly, compared to 46.7% of PHW. It was found that 59.1% of GHW and 40% of PHW had read official guidelines for cold chain maintenance. Only 14.5% of GHW and 26% of PHW had received training in cold chain maintenance. Eastern region: 23 health facilities were included, 15 GHF and 8 PHF. All workers in vaccination field were females 23 (100%); 93.3% Saudi and 6.7% non Saudis in GHF compared to 100% non-Saudis in PHF. Correct responses of total workers were as follows: regarding place of refrigerator inside the vaccination room, 86.3% of GHWs compared to 37.5% of PHWs; about the time of defrosting and knowledge of place of vaccine during defrosting all GHWs and all PHW (100%); and regarding water bottles in refrigerator 99.3% of GHWs compared to 62.5% of PHWs. Regarding placement of regular thermometer inside refrigerator 37.3% of GHWs answered correctly and 75% of PHWs; time of changing the temperature chart all GHWs (100%) compared to 87.5% of PHW; time of recording of temperature of refrigerator 93.3% of GHWs and all PHWs (100%); and the space between vials 86.7% of GHWs compared to 87.5% of PHWs. It was found that 93.3% of GHW and 62.5% of PHW had read official guidelines for cold chain maintenance. Only 86.7% of GHW and 75% of PHW had received training in cold chain maintenance. Knowledge: On the basis of the cumulative score, 30 workers (50%) were included in the high knowledge group and 30 (50%) in the low knowledge group. There were statistically significant higher knowledge scores among GHW 62.2% than private 30.4% (p=0.016), among Saudis 62.5% than non Saudis 38.5% (p=0.038), among workers who had read guidelines for cold chain maintenance (60.5%) compared to those who had not (26.3%) (p=0.0433), and among those who had received training in cold chain maintenance (68.6%) than those who had not (21.7%) (p=0.0023).
Conclusion
Knowledge of GHWs was better than PHWs. The weak points of knowledge of health workers were regarding location of refrigerator inside vaccination room, utilization of EPI refrigerator for storing other than EPI vaccines, position of vaccines inside refrigerator and spaces between them, in addition to how deal with VVM and its indication. This study revealed the importance of training health workers working in EPI. Training courses on cold chain maintenance should be held to all workers before joining work in the vaccination field. Courses should be held periodically to bring the workers knowledge up-to-date on cold chain maintenance.