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

[rn/writer, RN]

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.

If it's the case I'm thinking of (Triad products), the swabs themselves were contaminated with Bacillus cereus through a manufacturing error. This is not the norm.

http://www.jsonline.com/watchdog/watchdogreports/125695813.html

The culture medium I'm guessing you mean is agar agar.

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

If it's the case I'm thinking of (Triad products), the swabs themselves were contaminated with Bacillus cereus through a manufacturing error. This is not the norm.

http://www.jsonline.com/watchdog/watchdogreports/125695813.html

The culture medium I'm guessing you mean is agar agar.

Yes AGAR, THANK YOU! LOL Had a total brain lapse. I am not sure if that is the same case, it was traced back to childrens hospital because peripheral and PICC lines kept getting infected and they couldn't find the cause. The recall got to one of our health care facilities and all the wipes had to be recalled. (HUGE PAIN in a hospital obviously). I remember thinking how bizarre it was to have the very thing used to PREVENT infection, end up being the cause. I know it's rare though, that's why it was so hard to find the cause. No one thought to check the swabs.

[rn/writer, RN]

This was a case with national implications. A little boy in Houston Children's Hospital died from the infection caused by the contaminated wipes.

http://www.jsonline.com/watchdog/watchdogreports/124552053.html

Really tragic. But it wouldn't have been prevented by not wiping the vial. The contaminated wipes were used to swab the IV ports.

So sad.

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

That was probably it than. I only heard about the actual story secondhand when the wipes were recalled from a local hospital. Very sad indeed.

[sameyjaney]

I was told they are sterile...not to swab

[Hospice Nurse LPN, BSN, RN]

Swabber here. That's what I was taught in school, to swab w/ friction.

[JustBeachyNurse, LPN]

I used to work in a quality control microbiology lab for a contract drug manufacturer. Mind you this was specific for the company that I worked for and their clients (pharmaceutical and research companies) product specifications.

For parenteral medications, generally the cap is to protect the integrity of the stopper. The interior of the bottle & drug are intended to be sterile. While a clean room/sterile procedures are used for manufacturing the medications is used, whether the area between the cap and stopper on a bottle is sterile is dependent on the product specifications.

Usually if the cap of a vial is covered with a plastic over wrap, the external side to the stopper was considered to be sterile. If you remove the seal & cap and inject the stopper "immediately" thereafter, the stopper is considered sterile so you wouldn't need to swab/scrub the stopper. If you remove the cap while preparing your medication. (i.e. take the seal & cap off the vial, open your syringe package, open your needle, prep your syringe, etc.) and the stopper is exposed to a non-clean room environment (pretty much anywhere except possibly the OR) there is a possibility of contamination, then the vial stopper then needs to be scrubbed with sterile alcohol prior to injecting to remove the medication. (isopropyl alcohol or other appropriate sterile swab, providone iodine is not always recommended).

The microbiolgists in the lab would check sterility of the medication, swab, cap, internal bottle, and other areas during the quality control process (even if the cap/external stopper was not considered sterile it would be tested for specific environmental microbes.)

[Testa Rosa, RN]

I am still awaiting word on our hospital policy from our Awesome nurse educator who didn't have an answer at the ready.

Also got conflicting views from calling my pharmacists today on my 12 hr shift. The AM guy said swab; the PM gal said no swab needed. I am also emailing a couple of the makers of the vials I use a lot like Dilauded, Lasix, Protonix, Zofran, Benedryl, etc. Will let you know as I hear back.....if I hear back.

Thanks for all the awesome input my Allnurses Peeps. For now I think I will start swabbing.

TR

[Up2nogood RN, RN]

I always swab with friction. Pop off the top, immediately open an alcohol wipe, scrub. I don't exactly know how that could contaminate vs guessing the top is still sterile.

[Testa Rosa, RN]

TO SWAB.....seems to be the majority consensus. Thanks! TR

[xtxrn, ASN, RN]

I didn't swab new vials... I don't swab my Lantus vials, or insulin pens after opening them, either. :)

[hyunjoo82]

I am taught at my nursing school to swab everything just so you get in the habit of doing it to every vial. They do tell us that new vials may not need swabbing but it never hurts to take extra precaution, right? So now, I swab every vial, new or old. Forget the people who tell you that it's unnecessary--it's better to be safe than sorry.