Specially designed syringes maximize flu vaccine supply: syringes reduce costs and increase healthcare worker safety and patient comfort

Given the current flu vaccine shortage in the United States, healthcare providers can take a simple step to stretch their vaccine supply and provide vaccinations to more people while simultaneously reducing costs and improving safety.

As infection-control professionals know, drug manufacturers routinely over-fill medication vials to compensate for the waste space volume located in the syringe tip and needle hub and cannula. Recently, two separate studies demonstrated that using syringes with reduced waste-space volume to deliver flu vaccines can maximize available vaccine supply, in many cases allowing healthcare providers to draw an additional dose from each multi-dose vial.

During the 2003-2004 flu season, Texas Children's Hospital, Houston, used one such specially designed syringe to maximize its available vaccine supply: the BD Integra[TM] 3 ml Syringe. The Integra syringe is a safety engineered drug delivery device that can be activated using one hand--after the injection is administered the clinician continues to press the plunger, which activates a spring that retracts the needle into the syringe barrel, helping to eliminate accidental needlesticks. The syringe has wide flanges to offer increased stability and comfort for clinicians delivering medications. Its also has a clear barrel and bold scale markings to support dosing accuracy.

Using the Integra syringe to deliver 2003-2004 flu vaccines, Texas Children's Hospital drew greater than 10 full doses from nearly 62 percent of 10-dose flu vaccine vials, resulting in 7 percent more vaccinations and a savings of $0.74 per dose of vaccine. When the hospital drew vaccine from the same 10-dose vials with a conventional syringe, it achieved greater than 10 full doses from only 19 percent of the vials.

San Francisco's Test-med Vaccination Services, which provides flu vaccinations to companies at their facilities, had a similar experience. Using the Integra syringe to deliver its 2003-2004 flu vaccinations, Test-med drew greater than 10 full doses from 52 percent of the 10-dose flu vaccine vials.

"I have participated in annual influenza vaccine programs for the past 12 years and can honestly say that the times I used the Integra syringe were the best," said Linda Means, a registered nurse with Texas Children's Hospital. "The syringe allows you to draw out all of the vaccine from the bottle with very little drug waste."

Texas Children's Hospital

Texas Children's is the nation's largest pediatric hospital and ranked fourth among the top 10 pediatric hospitals in the nation, according to U.S. News & World Report's recently released list of America's best hospitals. The 697-bed hospital offers more than 40 pediatric subspecialties, including cancer, diabetes, asthma, HIV, premature birth and cardiogenic and attention-related disorders.

Texas Children's Hospital compared the low waste-space syringe against a conventional syringe to determine which one could draw the greatest number of doses from 10-dose influenza vaccine vials.

Two nurses from the hospital administered influenza vaccine from the vials using the Integra low waste-space syringe and two administered the vaccine using a conventional syringe. Over the course of several days during employee influenza vaccine clinics, each nurse drew vaccine from 26 vials.

A complete dose was considered 0.5ml. To get a complete dose, in some cases the nurses withdrew vaccine from more than one vial. The number of complete plus partial doses drawn from each 10-dose vial using the low waste-space syringe averaged 11.67 doses, compared with 10.98 doses using the conventional syringe.

Each of the 52 vials was labeled to contain 10 doses of vaccine for a total of 520 doses at a cost of $4,550. The nurses delivered 555 full doses with the low waste-space syringe compared with only 509 full doses with the conventional syringe. In the end, each dose of influenza vaccine cost $8.20 with the low waste space syringe, compared with $8.94 when using the conventional syringe.

Test-med

Like Texas Children's Hospital, Test-med tested the Integra low waste-space syringe to determine how many doses could be drawn from 10-dose 5 ml influenza vaccine vials. Using the syringe, four nurses from the facility each drew influenza vaccine from 25 vials over the course of several days during employee influenza vaccine clinics. From these 100 vials, the nurses drew 1,054 full doses of vaccine, increasing their vaccine supply by 5 percent. The average number of complete plus partial doses lip drawn during the test period was 11.58.

"This is the best-engineered, most reliable and safest syringe

in the industry," said Test-reed Director Jeff Wilmoth. "We are maximizing our drug sup plies and our nurses are no longer experiencing needlesticks--this reduction is so beneficial, it can't be measured."

Wanda Westcott, a registered nurse at Testmed said the nurses as well as the patients benefited from Integra's pain free injections. "Many patients asked, 'When are you going to give me the shot?' And I respond, 'I already gave it to you.'"

Denise Medina, RN, is a registered nurse and has been assistant director of Employee Health/Human Resources at Texas Children's Hospital for more than 15 years.

Judy Ross, LVN, is general manager of Test-med Vaccination Services and has been involved in medical management for 30 years.

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