Background: Syringes are commonly used in pharmacy compounding for the measurement of small volumes, especially in the preparation of sterile products for injection and infusion. However, there are no current official guidelines for the proper use of syringes in measuring small volumes. Objective: The purpose of this project was to determine the accuracy and precision of commercially available syringes in measuring small volumes during sterile product preparation to make recommendations for syringe size selection. Methods: To assess precision and accuracy of syringes, 3 separate investigators measured 5%, 10%, or 20% (n = 30 each) of the volume of a 1-, 3-, 5-, 10-, or 20-mL syringe with an attached 18G, 1½\" needle by drawing sterile water for injection from a vial. Delivered volumes were measured gravimetrically using an electronic balance and converted to volume using the specific gravity of water (1.0). Accuracy is represented as the mean and standard deviation, while precision is represented as percent relative standard deviation. Differences were assessed using a 1-way analysis of variance with Bonferroni adjustments and significance set at P < .05. Results: Precision and accuracy were highly variable and often significantly (P < .05) different compared to the theoretical volume delivered both within and between investigators. An increased likelihood of unacceptable error (>5%) was observed when less than 20% of the labeled capacity of a syringe was measured. Mean percent error ranged from 1.4% to 18.6%, despite manufacturer specification of ±5% accuracy, suggesting proper technique as a major factor in small-volume measurements. Conclusion: In addition to proper, validated training of syringe users, we recommend that users measure no less than 20% of the indicated volume of the syringe while choosing syringes as close as possible to the desired measurement. When possible, very small volumes should be diluted to meet the minimum volume of the smallest syringe available. Implementation of these recommendations will improve accurate dosing and, ultimately, patient safety.

An expert meeting on infection prevention was held in Baltimore on June 8-11, 1991, to establish consensus guidelines on infection control at family planning service delivery sites. Present were representatives of the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO), the WHO, IPPF, USAID and cooperating agencies. It was decided that instruments that penetrate the blood stream, such as needles, syringes, trocars and scalpels, should be sterile. High level disinfection (HLD), which kills everything except bacterial endospores, is satisfactory when sterilization is not available. HLD is the only way to disinfect a laparoscope, the endoscope of which cannot tolerate heat. The standard conditions for autoclaving instruments were set at 121 degrees Celsius (250 degrees Fahrenheit) of temperature, 15 lb/square inch (106 KPa) pressure, for 20 minutes for unwrapped, of 30 minutes for wrapped items. Sterilization by dry heat means 170 degrees Celsius for 1 hour, or 160 degrees Celsius for 2 hours, with added time for reaching temperature and cooling. Boiling is only acceptable as a method of HLD, not for sterilization. Boiling at a rolling boil for 20 minutes was recommended, with no correction for altitude. In the absence of an autoclave, surgical drapes are best prepared by ironing, since hanging them to dry would contaminate them after boiling.