Infection Control Today - 08/2003: SARS: Syringe Tip Caps Removed for Safety Reasons

Syringe Tip Caps Removed for Safety Reasons
No Breach of Aseptic Technique

By Michael Garvin, MHA

Healthcare workers (HCWs) will see a minor change in the upcoming months. Hypodermic syringes without needles that have been packaged with a tip cap will no longer have the cap placed on the tip of the syringe. The removal of the pre-packaged tip cap is a response to reports of an increasing number of choking incidents involving pediatric patients, some of which have required intense medical intervention.

We encourage enhancing the level of safety in our healthcare delivery environment, says Karen Tyson, president of the National Association of Pediatric Nurse Practitioners (NAPNAP).

The tip caps pose a remote hazard but even a remote hazard, if it can be eliminated, should be.

The risk is a result of HCWs using hypodermic syringes for the delivery of oral medications and the improper dispensing of parenteral hypodermic syringes to patients families to deliver oral medications. Either the tip caps are removed and left in the reach of children and then swallowed or not removed by care-provider and expelled into the childs throat We do not recommend that a hypodermic syringe be used for delivering oral medication, says Dr. Michael Hanson, director of the American Academy of Pediatrics (AAP). The AAP is joined by the NAPNAP, the Institute for Safe Medication Practices and the American Pharmacists Association in strongly advising against using conventional hypodermic syringes for the administration of oral medications.

Some HCWs have questioned the wisdom of eliminating the syringe tip cap, citing the need for the cap to provide a sterile barrier. In fact, the tip cap does not serve as a sterile barrier for the syringe.

The prepackaged tip cap was never designed to provide an aseptic barrier, says Brad Noe, the Becton Dickinson product manager responsible for the parenteral hypodermic business.

Sherry David, senior epidemiology nurse for the 700-bed University of Iowa Hospitals and Clinics, agrees.

The tip cap has holes and could not serve as anything but a physical protection. It certainly does not serve as a sterile barrier for the tip, she says.

When packaged, the syringe is sterile, with or without a tip cap. After opening, good aseptic technique has always required care that a syringe tip does not come into contact with any surface or fluid prior to a needle, blunt cannula or other sterile device being put on. Once the tip cap is removed from the syringe and set aside the sterility of the tip cap can no longer be assured, with or without holes.

Some HCWs use the syringe tip cap for other procedures such as when changing IV tubing sets. The technique is called using a dead ender when changing IV tubing sets. There are legitimate, appropriate applications for a sterile cap, says Noe. BD plans on providing separately packaged sterile, single use caps through 2003 to those clinicians, who have a clinical need for a sterile tip cap, at no cost.

The removal of the tip cap does not create an infection control problem, since the tip cap was never designed to provide a sterile barrier for the fluid path of the syringe and the tip cap is typically no longer sterile once it is removed from the syringe tip. The change is being made to enhance the level of patient safety in the health care delivery environment.

Michael Garvin, MHA, is a consultant and former safety engineer for the University of Iowa Hospitals and Clinics and the University of Wisconsin Medical Center.

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