| Summary: | 碩士 === 高雄醫學院 === 公共衛生學研究所 === 86 === AbstractVaccines will be harmful because of improper storage and
handling.Since there are 12 % to 19% of 260000 to 270000
newborns in Taiwanprovince are vaccinated in the hospitals and
clinics which arecontracted by the government health bureaus, it
is very importantto understand whether the vaccines cold chain
in this level are wellhandled.In this study, we sample some 200
from 600 hospitals and clinics inone-third ratio systematically,
which are contracted to providevaccination services with the
health bureaus or health centers. Wesurvey their refrigerators
with the cold chain monitors (3M''s product)from Jan. 1998 to
May. 1998. Since the health centers'' cold chainsystems had been
proved effectiveness, we sample 100 from 299 healthcenters in
the same way for comparison.The questionnaires are made for the
persons of the hospitals and clinicswho are in charged of the
vaccine management. There are two parts in thisquestionnaire,
one is completed by the vaccine managers of the hospitalsand
clinics. This part contains the basic information of the
hospitalsand clinics in operating vaccination services, their
equipment for vaccinestorage, the way they handle the vaccines,
the managers'' knowledge onhandling vaccines and how they get the
information about handling the cold chain. The other part is
completed by the workers of the health bureaus andthe health
centers in charged of vaccine management. It contains how
thehospitals manage the vaccines, whether the refrigerators
contain food ordrugs, the record of the refrigerator
temperature, the vaccine positionsin the refrigerators. The
visitors also had to check the hospitals andclinics vaccine
managers on how they read the refrigerators'' temperature,cold
chain monitors, freeze watches, and how they do the shake test
of thevaccine. 41 hospitals'' questionnaires and 135 clinics''
were collected andanalyzed, the results show: 1. Most the
hospitals and clinics'' OPD time isvery frequent that can offer
the parents in taking their babies to getvaccination. 2. The
vaccines'' transportation from the health bureaus orhealth
centers to the hospitals and clinics is safe since all
thetransportation''s finished in less than 30 minutes and the
vaccines are allstored in closed containers with ice bags. 3.
The hospitals and the clinics''vaccines at orage equipment are
not good enough because 34% hospitals and 48%clinics use one-
door refrigerators in which the temperature control is thoughtto
be much unstable. At the meantime there are also 95% hospitals
and 48%clinics don''t have any electric power suppliers to supply
power when theoutside one is broke. And this will increase the
potential dangers ofvaccine storage. 4. Part of the hospitals
and clinics vaccine mangers''knowledge does not enough, and this
may harm the vaccines'' potency inmistaking handling it.There are
42 hospitals, 142 clinics and 95 health centers finished in
therefrigerator monitoring using the cold chain monitors. The
result shows36.4% hospitals'' cold chain monitors and clinics''
changed colors at Adegree, 4.5% at B degree, and there is only
one clinic at C degree. Thereare 24.2% health centers (the
control group) changed color in A degree, andno one changed in B
and C degree. The odds ratio for hospitals and clinicsare 2.348
(1.086 - 5.074) and 1.979 (1.110 - 3.528) respectively usingthe
health centers as the reference. Because there are only few
hospitalsand clinics'' cold chain monitors changed color in B and
C degree and thepotency of vaccines is qualified in a reasonable
short times changed colorin A degree. We consider the vaccines
used in the hospitals and clinics aresafe If the health bureaus
can control the interval of the pick-up andquality of vaccines
without any of the following situations such as thelong period
shortcut of electric power, severe mechanic problems numbersand
ergonomic errors, the potency of vaccines will not be reduced
too muchas to affect the normal function of the vaccines.
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