Infection control problems using single use vials?

Nurses Safety

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During orientation for my hospital system's, the IV nurse educator said that the single use vials of normal saline we use are manufactured with porous plastic caps, so after breaking off the plastic cap, we should swab them with alcohol.

I work in an "outlying" hospital, and NONE Of the nurses I work with swabs off the rubber tops after removing the new caps, and they think I am crazy and wasting time. I have no idea if this hospital uses the same NS as the other hospital in the system that nurse educator is from. I do know that once I remove the cap, I see little "stars points" in the metal foil on the underside of the plastic cap-- it looks to me like that is how the cap was attached, and there MIGHT be gaps in the metal between these points where microbes could enter before the plastic cap is broken off.

Is there any way I can tell whether I need to swab the rubber tops, or if it is indeed a waste of time? The label indicates they are single use Hospirus 0.9% normal saline vials, but there are no instructions about cleaning the tops.

Thanks,

Greg

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I've never swabbed a just opened vial. If I was to draw it up again...yes I would swab.

Can't wait to hear the responses.

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During orientation for my hospital system's, the IV nurse educator said that the single use vials of normal saline we use are manufactured with porous plastic caps, so after breaking off the plastic cap, we should swab them with alcohol.

I work in an "outlying" hospital, and NONE Of the nurses I work with swabs off the rubber tops after removing the new caps, and they think I am crazy and wasting time. I have no idea if this hospital uses the same NS as the other hospital in the system that nurse educator is from. I do know that once I remove the cap, I see little "stars points" in the metal foil on the underside of the plastic cap-- it looks to me like that is how the cap was attached, and there MIGHT be gaps in the metal between these points where microbes could enter before the plastic cap is broken off.

Is there any way I can tell whether I need to swab the rubber tops, or if it is indeed a waste of time? The label indicates they are single use Hospirus 0.9% normal saline vials, but there are no instructions about cleaning the tops.

Thanks,

Greg

indeed, this applys to any 'flip" top vial.....and your observation is the reason....the rubber stopper is NOT sealed from outside air....if you need further back up , try the manufacturers

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Specializes in Cardiac, ER.

I swab everything before I draw up a med. Just a habit I got into many years ago. You are right though, many of my co workers don't swab a new vial. It makes me feel better, I do it! Of course I see co workers who don't swab the heplocks or the port on the IV tubing either!

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indeed, this applys to any 'flip" top vial.....and your observation is the reason....the rubber stopper is NOT sealed from outside air....if you need further back up , try the manufacturers

Actually, I've been searching the manufacturer's site to get their recommendation, and I can't find anything. I couldn't even find any mention of single use NS vials on Hospira's site.

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Specializes in Trauma, Pain Managaement.

I figure its never "crazy" to be too careful! =)

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Specializes in LTC, Med-SURG,STICU.

How much time are you wasting? I say clean the top off with alcohol and be done with it. I would rather error on the side of caution.

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Specializes in Infusion Nursing, Home Health Infusion.

Your IV Educator is 100 percent correct. All flip tops should be considered a dust cover and should be scrubbed with alcohol or the chlorhexadine (if that is what you are using) before use and that includes first time use. I will try to find you a reference,but I know this for a fact.

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Specializes in Mostly: Occup Health; ER; Informatics.

When in doubt, and the manufacturer can't tell you, look for research instead of forum opinions. The very first google page yielded all this:

"CONCLUSIONS. This study shows the lack of necessity of any disinfection procedure on the rubber stopper of single-dose vials and the efficacy of alcohol only for disinfecting the stopper of multiple-dose vials."

Defining unnecessary disinfection procedures for single-dose and multiple-dose vials. Am J Crit Care. 1994 Nov;3(6):448-51.

from

http://www.ncbi.nlm.nih.gov/pubmed/7834004?ordinalpos=13&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

And just for aiding your argument, articles about whether to disinfect multi-dose vials:

" At our hospital, we cultured 1,223 weekly samples from 863 MDV in-use over a three-month period. Medications included xylocaine, insulin, heparin, immunizations, and miscellaneous agents. None of the samples was culture-positive. "

http://www.ncbi.nlm.nih.gov/pubmed/6562087

"Our results showed that bacterial contamination of multidose injectable vials was not a significant hazard"

http://jcm.asm.org/cgi/reprint/17/2/377.pdf

"The authors collected weekly samples from 351 in-use MDV for seven consecutive weeks ... No vial yielded bacteria."

http://www.ncbi.nlm.nih.gov/pubmed/3994029?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed

Counterviews:

"In light of a possible high risk in this [1300-bed] hospital of about 1 contaminated MDV per day, and in view of many reported outbreaks induced by contaminated MDVs, the following infection control measures were encouraged: alcohol hand hygiene, the disinfection of gums [rubber], ..."

Am J Infect Control. 2004 Feb;32(1):12-6.

"A proportion of 4% of [96] vials was not sterile [after 4 months]."

Wien Med Wochenschr. 2007;157(15-16):398-401.

:specs:

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Thanks for doing the research, 3rdCareerRN! Especially thank you for including citations, although they muddy the water a bit. For instance, although the first article concludes that disinfection isn't needed, in the body of the abstract it states "Of the cultures done on single-dose vial stoppers, 99% were sterile".

I will try to access the full article and see what the results were on the non-sterile vial tops. My only other concern is that the study was done in 1994, and controls might not be as strict today, especially if vials are made overseas.

Greg

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Specializes in Vascular Access.
Your IV Educator is 100 percent correct. All flip tops should be considered a dust cover and should be scrubbed with alcohol or the chlorhexadine (if that is what you are using) before use and that includes first time use. I will try to find you a reference,but I know this for a fact.

It really depends on the manufacturer. We use the 10cc PF saline vials and occasionally the 30cc multi-dose vials. They are not just dust covers, but are sterile underneath the cap. Now if the cap has been removed.. then... scrub, scrub, scrub.

Doubts?

Call Hospira and ask the medical dept. yourself.

And if it is sterile underneath the cap, you can scrub with alcohol prior to drawing up fluid, but it is NOT neccessary.

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You are supposed to swab the stopper even if you just unsealed it and even if it is for only one dose. This is clearly stated in my Fundementals of Nursing Text by Potter and Perry on page 739. "Not all drug manufacturers guarantee the caps of unused vials are sterile. Therefore swab seals with alcohol before preparing medication. Allowing alcohol to dry prevents needle from being coated with alcohol and mixing with medication."

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