alcohol pads and cleaning

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    ok. I am lost. I just started in a LTC facility. maybe I am just not "up to date". but this place does not used alcohol to clean off any tops of bottles before they stick their needels in like for TB injections, or insulin. are you supposed to anymore? or to even clean off the skin before you inject? they told me they do not do it for the TB test because it "interferes" with the TB stuff...i can understand that...but are we not introducing "stuff" into the skin when we inject the medications on unclean skin? by not cleaning it? I am very scared not to do this? and State is comeing monday. I am the new unit manger. I want to almost ask them what we need to do. I know I already to to "correct" the wound team. that team of LPN's drives me crazy. I am in school to become a WOC nurse and that is one reason they hired me, this "team" of nurses uses one pair of gloves from start to finish for wound care.
    please tell me. am I just lost? did I do everything wrong while I was in home care the last 4.5 years? maybe i have and haven't kept up on infectious disease stuff.

    thanks!!!
  2. 12 Comments so far...

  3. 0
    Quote from bebop1
    ok. I am lost. I just started in a LTC facility. maybe I am just not "up to date". but this place does not used alcohol to clean off any tops of bottles before they stick their needels in like for TB injections, or insulin. are you supposed to anymore? or to even clean off the skin before you inject? they told me they do not do it for the TB test because it "interferes" with the TB stuff...i can understand that...but are we not introducing "stuff" into the skin when we inject the medications on unclean skin? by not cleaning it? I am very scared not to do this? and State is comeing monday. I am the new unit manger. I want to almost ask them what we need to do. I know I already to to "correct" the wound team. that team of LPN's drives me crazy. I am in school to become a WOC nurse and that is one reason they hired me, this "team" of nurses uses one pair of gloves from start to finish for wound care.
    please tell me. am I just lost? did I do everything wrong while I was in home care the last 4.5 years? maybe i have and haven't kept up on infectious disease stuff.

    thanks!!!
    We were taught if you grabbed a vial AND the vial had a cap, that wiping with alcohol wasn't necessary when the cap was removed, because it was sterile underneath. However, obviously, if you touched it b/c of difficulty of removal or it didn't have one...wiping was necessary.

    When I had my TB test, the nurse did swipe with alcohol, but she wiped right behind it once with a 2x2 and waited for it to dry before starting the test.

    I have seen this new 'trend' in not wiping with alcohol before injections and we are taught under no circumstances are we to get on board with that...it only takes ONE pathogen to enter successfully that multiplies and every break in the skin is a portal.
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    That is just, well, bad practice. I always wipe and wait for ETOH to dry. I once got a very bad blood poisoning all the way up my arm into the lymph nodes in my pits because of bad practice from phlebotomy. Red streak all the way up. Was in hospital for 2 days. Called up the practice where this was done and suggested they retrain the personnel. ALWAYS prep using sterility when puncturing someones skin!!
    BabyLady likes this.
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    Agree this is BAD practice. The cap on vials should be considered a dust cover only and be scrubbed with an alcohol pad each and every time it is accessed. Yes skin needs an alcohol scrub as well!!!!! Actually new research even points to the fact that bacteria also live in the deeper layers of the skin!!!! Does someone really think this is not necessary?...that is a bit shocking. You need to present the evidence and change this practice immediately.
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    I was e-mailing my instructor on this (we were e-mailing about something else and I just figured I would get the rationale behind it).

    She said that the caps on vials are not "dust covers", they are there to protect the sterility of the top when you remove the cap. They are heat sealed.

    She said that it works because if you have ever tried to remove the cap, you can never get it to go back on the vial because when you take it off, the rim springs into a shape that is smaller than it was before.

    The "flip cap" is actually called a "safety cap".

    Obvious, if you withdrew a second dose of a med from the same vial sometime later, you would need to swipe again.
    Last edit by BabyLady on Feb 23, '09
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    Yes I know you cannot reattach them and they are sealed by the manufacturer as I have popped of thousands in my career. My point was that you still need to swab them before use. Check some out...can dust get under them and near them.....I say yes and I say swab before use.
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    At the annual 'blitz' at the hospital - where nurses go to do a check-off on all skills - we were told that the newest research says to not only wipe vial tops and IV ports, etc with alcohol, but to do so for 15 seconds. They had a short video to drive home the point, showing the bacterial growth under special lights. Bacteria will indeed still hand around if you don't wipe for long enough.
    iluvivt likes this.
  9. 0
    thank You SusanKathleen......my point exactly.....Pharmacy does the learning station at our annual skills lab and this is how they instructed us, as well...and I trust them.
  10. 0
    Thank you thank you thank you.

    I was like....how in the world did my 4.5 years working in home health did the rest of the world go crazy! lol...... the same I found out with the blood sugars! I was down a nurse yesterday so I did the med cart. and I went to check blood sugars. and maybe this is wrong too...I clean their dirty little hands with alcohol...wiped it with a 2x2 and allowed it to dry. then I poked their finger to check it? is that wrong? or to give them all the shots? its crazy. I will going into the direct tomorrow. because know I feel better that ya all are out there telling me I am not crazy.

    thank you!!!!!:spin:
  11. 0
    bad bad bad practice....while I'm only a student, it seems utterly retarded to me to NOT use alcohol wipes in those situations.....seriously how long does it take? Is the cost of alcohol wipes really going to break an institution's profit margins? I would never let anyone inject anything into me without cleaning my skin first, nor would I stay quiet about it either....


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