Literature-Based Health Risk Analysis on Long-Term Pharmaceutical CCP Storage Temperature Exposure on Warehouse Operator
DOI:
https://doi.org/10.59024/jikas.v4i4.2392Keywords:
Cold Chain Product, Literature-Based, Operators’ Health, Risk Analysis, Storage RoomAbstract
Warehouse operators working in pharmaceutical Cold Chain Product (CCP) storage areas are frequently exposed by low temperatures ranging from 2 to 8°C. This condition may affect the operators’ long-term health condition since there are no operational standards in companies or regulators that regulate the operator changes schedule on CCP area. This narrative literature-based risk analysis was performed using articles collected from Taylor and Francis, ScienceDirect, and Google Scholar databases published around 2025-2026. From five included studies, various health conditions were classified to four severity levels (negligible, minor, moderate, and severe). It ranged from reversible responses, such as decreased skin temperature and minor respiratory infections, to moderate and severe conditions involving cardiovascular and respiratory impairment, as well as cellular apoptosis. The risk analysis proves that cold exposure may lead to cumulative physiological stress and progressive health risk. These findings are considerable for regulators to ensure occupational safety regulation on CCP environments.
References
Badan Pengawas Obat dan Makanan Republik Indonesia. (2025). Peraturan Badan Pengawas Obat dan Makanan Nomor 20 Tahun 2025 tentang standar cara distribusi obat yang baik. BPOM RI.
Chhay, S., & Scheckelhoff, D. (2023). Cold chain management in health systems: Navigating a complex and evolving landscape. American Journal of Health-System Pharmacy, 80(22), 1601–1602. https://doi.org/10.1093/ajhp/zxad219
Cong, P., Liu, Y., Liu, N., Zhang, Y., Tong, C., Shi, L., et al. (2018). Cold exposure induced oxidative stress and apoptosis in the myocardium by inhibiting the Nrf2-Keap1 signaling pathway. BMC Cardiovascular Disorders, 18(1), 36.
Farbu, E. H., Höper, A. C., Reierth, E., Nilsson, T., & Skandfer, M. (2022). Cold exposure and musculoskeletal conditions: A scoping review. Frontiers in Physiology, 13, 934163. https://doi.org/10.3389/fphys.2022.934163
Feyisa, D., Jemal, A., Aferu, T., Ejeta, F., & Endeshaw, A. (2021). Evaluation of cold chain management performance for temperature-sensitive pharmaceuticals at public health facilities supplied by the Jimma Pharmaceuticals Supply Agency Hub, Southwest Ethiopia: Pharmaceuticals logistic management perspective using a multicentered, mixed-method approach. Advances in Pharmacological and Pharmaceutical Sciences, 2021, 5167858. https://doi.org/10.1155/2021/5167858
Ilyass, B., Fadoua, B., Hajar, Z., Yasmina, T., & Yassir, B. (2025). The cold chain of biotherapies within a hospital pharmacy: Evaluation of the process and dispensing practices. Journal of Pharmaceutical Research International, 31(12), 226–233. https://doi.org/10.9734/jpri/2025/v37i127794
Iyer, P., & Robb, D. (2025). Cold chain optimisation models: A systematic literature review. Computers & Industrial Engineering, 204, 110972. https://doi.org/10.1016/j.cie.2025.110972
Jin, H., Zhang, X., & Ji, G. (2026). Research and application advances in novel cold storage refrigerated warehouses. Journal of Energy Storage, 141, 119061. https://doi.org/10.1016/j.est.2025.119061
Kumar, N., & Jha, A. (2017). Temperature excursion management: A novel approach of quality system in pharmaceutical industry. Saudi Pharmaceutical Journal, 25(2), 176–183. https://doi.org/10.1016/j.jsps.2016.07.001
Lee, H., & Yoon, H. Y. (2024). Impact of ambient temperature on respiratory disease: A case-crossover study in Seoul. Respiratory Research, 25, 73. https://doi.org/10.1186/s12931-024-02699-0
Li, Y., Wu, J., Xu, Y., Dong, J., Xing, B., Wang, Y., et al. (2026). Cold exposure and the cardiovascular system: From physiological adaptation to pathological risk. Frontiers in Physiology, 16, 1740919. https://doi.org/10.3389/fphys.2025.1740919
Lin, Y., Liu, Z., Su, H., Xiao, J., Liao, X., Zou, M., et al. (2026). The burden of cold-induced hypertension: Integrating molecular mechanisms and preventive strategies. Ecotoxicology and Environmental Safety, 309, 119731. https://doi.org/10.1016/j.ecoenv.2026.119731
Mifsud, T., Modestini, C., Mizzi, A., Falzon, O., Cassar, K., & Mizzi, S. (2022). The effects of skin temperature changes on the integrity of skin tissue: A systematic review. Advances in Skin & Wound Care, 35(10), 555–565. https://doi.org/10.1097/01.ASW.0000833612.84272.da
No., M., & Kwak, H. B. (2016). Effects of environmental temperature on physiological responses during submaximal and maximal exercises in soccer players. Integrative Medicine Research, 5(3), 216–222.
Nyirimanzi, J. D., Ngenzi, J., Kagisha, V., Bizimana, T., & Kayitare, E. (2024). Assessment of medicines cold chain storage conformity with the requirements of the World Health Organization in health facilities of the Eastern Province of Rwanda. Journal of Pharmaceutical Policy and Practice, 16(1). https://doi.org/10.1186/s40545-023-00534-3
Rafieian, M., Höper, A. C., Stjernbtandt, A., Tapper, R., & Ikäheimo, T. M. (2026). Lack of guidelines for cold exposure among vulnerable outdoor workers. International Journal of Circumpolar Health, 85(1), 2619359. https://doi.org/10.1080/22423982.2026.2619359
Rafieian, M., Farbu, E. H., Höper, A. C., Valtonen, R., Hyrkäs-Palmu, H., Perkiömäki, J., et al. (2025). Blunted cardiovascular responses in individuals with type 2 diabetes and hypertension during cold and heat exposure. Frontiers in Physiology, 16. https://doi.org/10.3389/fphys.2025.1558471
Ranasinghe, T., Loske, D., & Grosse, E. H. (2025). Cold storage, warm breaks: The effects of rest breaks on order picking performance in cold-storage environments. International Journal of Production Economics, 283, 109560. https://doi.org/10.1016/j.ijpe.2025.109560
Sun, B., Wu, J., Li, C., Shen, S., Han, X., & Hu, Z. (2025). Skin temperature indices to evaluate thermal perceptions and cognitive performance in cold environments. Energy and Buildings, 332, 115425. https://doi.org/10.1016/j.enbuild.2025.115425
Weidmann, M. D. (2025). The association between temperature variability, morbidity and mortality for specific categories of disease: A systematic review and meta-analysis. Hygiene and Environmental Health Advances, 14, 100123. https://doi.org/10.1016/j.heha.2025.100123
World Health Organization. (2026). TRS 1025—Annex 7: Good storage and distribution practices for medical products. https://www.who.int/publications/m/item/trs-1025-annex-7
Yan, R., Liu, S., Liu, J., Zhen, L., Gu, Y., Ying, S., et al. (2026). Low temperature and cold spells on arrhythmia onset: An individual-level case-crossover study in Minhang District, Shanghai, China. Ecotoxicology and Environmental Safety, 312, 119951. https://doi.org/10.1016/j.ecoenv.2026.119951
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