To Swab or Not to Swab......

[Testa Rosa, RN]

Does anyone know what the current practice is regarding alcohol swabbing new single use vials after you pop off the tops prior to drawing up the fluid?

There seem to be two camps of thought:

One says that the vial is sterile since you've just popped off the top and alcohol swabbing is unnecessary.

The other camp says swab everything prior to drawing up meds even on single use vails. The reasoning being that the pop off tops are just there to protect the top not necessarily to keep the top sterile and you should always swab every vial even single use prior to drawing up the fluid.

I was just audited by a very detailed RN who is the "swab everything" camp; Therefore I am now swabbing everything. However, I still see other nurses not swabbing before using single use vials who watch what I'm doing (the gift and curse of being the only new RN on the floor and having a wonderful support) and tell me its unnecessary.

I just want to know if anyone else has any input or research you can point me to.

Thank you, TR

[caliotter3]

No wonder we get headaches. Arguments for both sides make sense to me.

[Anna Flaxis, BSN, RN]

I was taught in NS to swab, the rationale that the vials are not necessarily sterile under the caps. Never did the research to find out, though. I'm curious to know, because if they are sterile, then there is no need to swab, which would save me so much time!

[MN-Nurse, ASN, RN]

I just want to know if anyone else has any input or research you can point me to.

At school they told us to swab everything so I swab everything. I would suggest following facility policy. If you have an evidence-based practice dept/person, you can bring your research findings to them.

[franko98]

When in doubt...swab it. Why take the chance of introducing something unneccessarily to your patient. My instructors always reminded me that these meds were going straight into the bloodstream and we are the defense against infection and injury. I always swab. 3 seconds and a swab later....my conscious is clear and my patinet is safe.

[MunoRN, RN]

The CDC's recommendation for both single and multi-use vials: "Proper hand hygiene should be performed before handling medications and the rubber septum should be disinfected with alcohol prior to piercing it."

I've read supposed "best practice" sources that say it's not necessary. My understanding is that the surface of the rubber stopper is not sterile, the cap is only their to protect the stopper and prevent tampering. Swabbing with alcohol doesn't make it sterile either, maybe some sources say it's not necessary because the potential bacterial contamination on the stopper isn't really greater than what could be left on the stopper after swabbing?

[franko98]

It's not the alcohol alone that kills the bugs but the friction along with the alcohol that destroys.

[rn/writer, RN]

Sometimes I accidentally touch the vial top when I snap off the little plastic lid. I swab because I'm not always sure whether I did or didn't.

Wonder if there are any studies on just how sterile those tops are when the lid is first removed.

[iluvivt, BSN, RN]

YES you need to cleanse the vial tops......100 percent certain See the APIC (Association for Professionals in Infection Control positon paper on Safe injection,infusion and medication vial practices in all setting 2010. They may have a 2011 but if nothing has changed a new version may not be available

it states that you must disinfect IV ports and vial stoppers by wiping and using friction with sterile isopropyl alcohol (IPA) ,ethyl ethanol alchol,idophor or other approved antiseptic swab. Allow the port/vial to dry before accessing.

You can also refer to the 2008 USP revised general chapter (USP 797) that apply to compounded sterile preperations ..it says the same thing plus a lot more

maybe I can attach the APIC position paper when I get home..of interest it is not just a quick swipe..it is actually a scrub with friction . its really interesting

[rn/writer, RN]

I Goggled and got so excited when I found an entry called, "To Swab or Not to Swab." Then I realized it was this very thread.

It is interesting to note that all of the manufacturer instructions that I ran across during this search said to swab. Maybe it's just a CYA thing, but it's there.

[turnforthenurse, MSN, NP]

I was told the tops aren't sterile. Also, depending on how you pop it off could cause contamination. I like to hold the vial and then pop off the top with my thumb and of course there is a chance of my thumb touching the rubber part underneath the top, thus causing contamination. I always use an alcohol swab on them.

[orangecampino]

I was told the tops aren't sterile. Also, depending on how you pop it off could cause contamination. I like to hold the vial and then pop off the top with my thumb and of course there is a chance of my thumb touching the rubber part underneath the top, thus causing contamination. I always use an alcohol swab on them.

Yes, this. It is our health authority's policy to swab, and I think it makes sense because a) the tops of the vials aren't guaranteed to be sterile, and b) even if the tops were sterile, they could become contaminated as the cover is flipped off. Why risk it?

[~Mi Vida Loca~RN, ASN, RN]

It is unnecessary and a potential source of contamination to swab a newly opened vial.

If the seal on an unopened vial is intact prior to use, it is sterile, and therefore swabbing with alcohol is unnecessary. If the seal on an unopened vial is NOT intact prior to use, the entire vial must be considered to be contaminated, and the med discarded without being used.

When you open a sealed vial, you may actually contaminate it by swabbing it unnecessarily if you accidentally touch the alcohol swab to the countertop, your hand or the outer surface of the package. Why take that chance?

This is what we were taught and what my facility does. Only swabs multi use vials with no tops.

On a side note, did anyone hear about the infections in lines caused FROM the alcohol swabs? Major recall once the source of infection was finally tracked down to the alcohol swabs.

Can always get a sterile swab and swab the top and put on augor? agor? the spelling is escaping me. Anyway, see if anything grows.