Healthcare Providers Can Use Several Strategies to Maximize COVID-19 Vaccines

By Carolyn Crist

February 19, 2021

NEW YORK (Reuters Health) - Healthcare practitioners can consistently get the most out of each vial of COVID-19 vaccine by using certain syringes and needles and considering waste with pre-drawn syringes, according to the U.S. Pharmacopeia.

The USP created a COVID-19 Vaccine Handling Toolkit to help providers withdraw the highest number of doses from each vial, whether six or seven doses from the Pfizer-BioNTech vaccine or 11 doses from the Moderna vaccine.

"We're in a race against time and need to get more shots in arms as quickly and as safely as possible," said Dr. Farah Towfic, director of CEO operations for USP, who led the toolkit initiative.

To create the toolkit, the USP team brought together a group of immunization experts who developed strategies to maximize vaccine supplies and build a national and global standard for COVID-19 vaccines. The toolkit is available for free and featured on the homepage.

"In the U.S., we're trying to immunize 300 million people, which will use 600 million doses," she told Reuters Health by phone. "It's absolutely imperative that we maximize every single dose out of a vial in the race to vaccinate as many people as possible."

The toolkit covers three aspects of vaccine administration: preparation, storage and transportation, and waste minimization and supply disposal. While preparing and withdrawing doses, providers should be aware of the different types of syringes, such as low-dead-volume, non-low dead-volume and pre-drawn syringes.

Each option has a unique use that can reduce the waste of syringe supplies, the toolkit authors write, though providers should opt for low-dead-volume syringes and needles whenever possible.

A low-dead-volume syringe is designed to limit the dead space that exists between the syringe hub and the needle. A low-dead-volume needle is designed with less space between the needle and the plunger.

In some cases where not enough low-dead-volume syringes are available, a combination may be useful, such as three low-dead-volume syringes and three non-low-dead-volume syringes for the Pfizer-BioNTech vaccine to withdraw six doses, the toolkit authors write.

In addition, Pfizer recommends a 21-gauge or narrower needle to prevent leaking from the stopper when doses are withdrawn. Since Moderna recommends a 20-22-gauge needle for dose preparation and a 22-25-gauge needle for administration, USP recommends a 22-gauge needle for both preparation and administration of the vaccine.

The toolkit also offers detailed steps for reconstituting the vaccines to help maximize the number of doses, as well as strategies to pre-draw the vaccine into syringes for efficient administration. Providers should carefully consider the number of pre-drawn syringes to prepare to minimize waste, the authors write, and use pre-drawn syringes with the earliest discard time to avoid spoilage.

In addition, providers should refrain from using transfer devices, mini spikes or one needle to prepare multiple syringes due to the potential loss of medicine in dead space. Dispensing pins and needleless devices may also lead to vaccine loss or be incompatible with vaccine materials.

Rotating and inserting the needle in various locations of the vial septum can also reduce leaking of the vaccine and maximize the number of doses.

USP plans to update the toolkit as more COVID-19 vaccines receive authorization from the U.S. Food and Drug Administration this spring. The team is also developing a global version of the toolkit to help providers in different countries to maximize their doses.

So far, Dr. Towfic and colleagues at the USP have received feedback that the strategies have helped providers to deliver 50% more immunizations, particularly at large vaccine clinics and within large health systems. Local independent pharmacists have also been able to get more out of their vials and better serve their communities, she said.

"Delivering 50% more immunizations is exciting because that's how we're going to get to the other side of this pandemic," Dr. Towfic said. "We hope this builds confidence for healthcare providers, as well as confidence for patients."

SOURCE: U.S Pharmacopeia COVID-19 Vaccine Handling Toolkit.