Prefilling and storing syringes can implicate IC, patient safety

By: April 14th, 2010 Email This Post Print This Post

I recently received a question from a facility about how long you can store a prefilled syringe before administration.

Not long, is the short and simple answer to this question; not at all, to be more precise.

The National Center for Immunization and Respiratory Diseases (NCIRD) strongly recommends that providers draw vaccines only at the time of administration, and prefilled syringes shouldn’t be stored for any length of time.

Your facility may receive medication or vaccines from a supplier that is prefilled. Those manufacturer-filled syringes are okay to use because they are prepared under sterile conditions and manufacturers are required to follow specific standards for handling and storage.

The NCIRD cites a number of complications that can result from prefilling and storing syringes:

  • It makes it difficult to identify different vaccines and medications
  • There is a greater risk for storing the vaccine or medicine under inappropriate conditions
  • Prefilled syringes can become contaminated, and most are designed for immediate administration
  • Vaccine components could interact with the plastic syringe components and potentially reduce the potency of the medication

Perhaps most importantly prefilling syringes elicits myriad patient safety and infection control considerations. If you aren’t the one who draws up the vaccine yourself, you have no assurance of the sterility of the dose.

Influenza vaccines are the most common example of this practice. Once the vaccines arrive at the medical facility, it’s the facility’s job to properly store them. You can download vaccine storage checklist on the Tools page of OSHA Healthcare Advisor.

For related infection control information including safe infection practices, program building, and infection prevention best-practice, register for the April 21st Webcast, “Infection Prevention Survey Strategies for ASCs: Comply with CMS’ Conditions for Coverage.”

Comments

Would this recommendation apply to times when mass administration is being done? Our facility has a flu clinic day. To keep things flowing smoothly we like to fill several syringes at a time to keep the lines moving.

Would this recommendation apply to insulin in the home health setting?

Does this apply in the home setting? Our practice for patients that cannot prefill Insulin syringes correctly is to prefill up to 2 weeks at a time.

We only prefill syringes 72 hours or less due to stability of insulin in syringe. Home health settings will be challenged if this is the recommendation.

By Sutten Compton on April 14th, 2010 at 2:31 pm

What about oral medications. We are looking at a PO narcotic and feel that filling the syringe when the medication arrives is the best way to document inventory.

What about Heparinised Saline syringes which are used to flush “short lines” eg. Heplock. Syringes are dated and labelled and changed every 12hrs. These are kept on the shelf with the needle intact with cover. Is this okay. I have in the past sent off samples to Microlab as an environmental check – no micro-orgs cultured.

Does this apply to homecare patients. Many of the patients we see need prefill and under Medicare guidelines you cannot visit on a daily basis for this they will simply not pay for the visit.

Dermatology dept are notorious for pre filling lidocaine syringes and leaving them in cupboards for weeks, unlabeled.
Go check your Derm dept, I promise you will find their stock, and they don’t see what the problem is. I’m facing major push back from Admin to stop them from this unsafe practice.

Regarding pre-filling syringes with lidocaine – if they are labeled appropriately, is that acceptable, and if so, when should they be discarded? at the end of the day? I also know of places where they may be drawn several days in advance, and it does not seem like a safe practice to me…

I have the same question as Ivan. I need advise how to handle those requests for pre-fillinning syringes with lidocaine.

 

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