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

August 1, 2003

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

By Michael Garvin, MHA

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

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

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

The risk is a result of HCWs using hypodermicsyringes for the delivery of oral medications and the improper dispensing ofparenteral hypodermic syringes to patients families to deliver oralmedications. Either the tip caps are removed and left in the reach of childrenand then swallowed or not removed by care-provider and expelled into the childsthroat We do not recommend that a hypodermic syringe be used for deliveringoral medication, says Dr. Michael Hanson, director of the American Academy ofPediatrics (AAP). The AAP is joined by the NAPNAP, the Institute for SafeMedication Practices and the American Pharmacists Association in stronglyadvising against using conventional hypodermic syringes for the administrationof oral medications.

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

The prepackaged tip cap was never designed toprovide an aseptic barrier, says Brad Noe, the Becton Dickinson productmanager responsible for the parenteral hypodermic business.

Sherry David, senior epidemiology nurse for the700-bed University of Iowa Hospitals and Clinics, agrees.

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

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

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

The removal of the tip cap does not create aninfection control problem, since the tip cap was never designed to provide asterile barrier for the fluid path of the syringe and the tip cap is typicallyno longer sterile once it is removed from the syringe tip. The change is beingmade to enhance the level of patient safety in the health care deliveryenvironment.

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