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The Effects of Sorting on EpiPen Epinephrine Auto-Injector Device Integrity and Function

Julie C. Brown*, Alex Q. Cooper, Hannah G. Parish, Pingping Qu

Background: Prescribing information for EpiPens state that the carrier tube is not waterproof. No studies have shown the effects of submerging EpiPens in water. Objective: We aimed to determine the function and integrity of EpiPens after washing in a washing machine.Methods: For 68 pairs of same-dose, same-lot, post-consumer expired EpiPens (Fifteen 0.3mg and fifty-three 0.15mg), one was washed in its carrier tube in top-loading washing machine, while its pair was kept at usual conditions. Both were then fired into meat. The increase in meat mass and decrease in device mass were measured to estimate the mass of solution fired. Paired t-tests measured if the average difference in mass between washed devices and control devices differed. Generalized estimating equations assessed the effects of device dose (0.3 mg vs. 0.15 mg) and expiration date on the difference in outcomes. An additional 14 washed but unfired devices were dissected to assess for moisture and damage.Results: Washed devices fired a greater mass of epinephrine solution into meat during firing, versus controls (0.353 vs. 0.257, paired t-test p-values <0.0001). (0.353 vs. 0.257, paired t-test p-values <0.0001). Devices lost more mass during firing, (0.396 vs. 0.263, paired t-test p-values <0.0001). Ten washed devices failed to deploy the needle cover after firing. The effect of washing did not differ by dose or expiration date. Fifteen unfired dissected devices had moisture around the syringe but dry needles. Conclusion: Washing EpiPens impaired their function. These devices should not be used if accidentally placed through a washing machine cycle.