Pre-Filled Syringes in the OR
Making the switch to pre-filled syringes (PFS) is a complex decision. You'll have to consider many factors, including budget, staffing, flow of care in the OR, availability of drugs you'd like to purchase, and purchase volume. Removing cost from the equation, many practitioners and nurse managers ask me why they should consider pre-filled syringes. Simply put, moving towards PFS is the most effective way to ensure compliance in your OR.
THE "POCKET" SYRINGE Picture this: surveyors arrived unexpectedly this morning. You and your staff are doing an amazing job, and for an unannounced survey, you feel pretty great about how things are going. Surveyors are happy, you're happy, and the phrase "flying colors" is almost out of your mouth. Until the "pocket syringe" happens. We've all met that doctor who forgets to label the syringe, who prepares 15 syringes at 6am for their cases all day long, who doesn't quite grasp the magnitude of USP <797>. The surveyor, who has been so impressed up until now, stops to say hi to that doctor... and sees the "pocket syringe". Pre-filled syringes remove this scenario from any and all possibility. Your staff have access to the PFS with extended room temperature beyond use dates (BUDs of 30, 60, 90, or maybe even 120 days at room temperature). There is no worry about labeling compliance, since PFS come pre-labeled. And because they're single use, you can store them in the anesthesia carts (non-controlled substances, of course). Bottom line... PFS = no more "pocket syringes".
THE "PRE-TURNOVER" PREPPER Your practitioners and staff are doing great! Not a single person has pre-drawn a syringe outside of 60 minutes in months. In fact, your practitioners are prepping their syringes between cases in the OR. Excellent. There's just one problem: practitioners are prepping the meds while the room is still being turned over. In order to prepare medications in the OR between cases, that entire room must be turned over completely. Including the anesthesia cart top. It must also be dry (ask your infection control consultant). I completely understand the pressures of outpatient surgery and turnover times. But medication preparation is not a corner to cut. I've encountered practitioners prepping their syringes on the anesthesia cart while the room is being turned over around them. I've also been told about practitioners that don't turnover the top of their carts because they're already prepping for their next case as soon as the patient is removed from the OR. If we want to talk about cutting down on turnover time, pre-filled syringes is part of that conversation, but not med-prep during room turnover. As I mentioned above, PFS can be stored right in your anesthesia cart or locked cabinet in the OR. If it's a controlled substance, those PFS can be signed out from main inventory each morning the same way vials are.
CONSERVATION EFFORTS Re-using shopping bags? Great way to make a positive environmental impact! Re-using syringes? Not so much. We all understand "One Patient. One Needle. One Time". But when we're talking about sterile environments, materials that don't touch the patient, and seemingly uncontaminated containers, practitioners raise a lot of questions, and understandably so. SCENARIO: If your OR has been turned over completely (check), and you're prepping medication within 60 minutes of use (check), and you're in an appropriate mediation preparation area such as the back counter of an OR (check), and there are no patients in the room, do you need to use a new syringe each time you transfer medication from a vial to a labeled sterile cup? Or can you use the same syringe to transfer from vial to sterile cup, each time you prepare a new sterile cup, all day long? The answer: You must use a new syringe and needle each time you prepare medication, all day long. Syringes should not be kept for preparation of later cases, even if those syringes never come into contact with a patient. If you have questions about what materials can stay in the room between cases vs what must be disposed of, contact your infection control consultant.
Beyond the microorganism contamination risk, there is also the question of appropriate use of medical equipment. They say a picture is worth 1000 words. Take a look at what a needle looks like after being used more than once. Re-using the same needle causes degradation, and as you can see in this picture, greatly increases the risk of particulate contamination.
Making the switch to pre-filled syringes could alleviate the need for preparing those medications between cases. Including any potential for re-using syringes to prepare medications for multiple cases.
A final word on the topic: USP <797> strictly prohibits entrance into the same original manufacturer's container more than twice for immediate use compounding (this is the type of mixing and medication preparation commonly performed in outpatient surgery centers).