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.
I'm an instructor at a nursing school. I personally used NOT to swab new one-use vials. But once I started teaching I cleaned up a lot of my own practices in order to give a good example and follow the practices of my school.
I decided that it's a good thing to carry out such procedures as swabbing everything always between any two accesses because if it's a constant, reliable habit, then you'll never forget. It's similar to identifying your patient every time you do an intervention - of course you know that person well by the middle of the day, and it's not really necessary to check who they are. But you'll never make a istake if you ALWAYS carry out these procedures. Be safe.
I'm in the PICU and we use the chloraprep scrubs (the square ones, like an alcohol pad) to scrub EVERYTHING. The tops of vials, IV caps, tubing caps, tubing ports, etc. Scrub for 30 seconds, dry for 30 seconds...it's a little tedious (and sometimes 30 seconds is more like 10 or 15), but our unit did not have any catheter associated BSI's for a (very) long time...I want to say it was only a week or two shy of a year! I'm not sure if or how it's related to the scrubbing of vials or anything else, but I don't think that it hurts.
I was taught to swab. I even saw some of the dirt come off on the swab myself. I was surprised and grossed out and I know that some don't swab depending on who their clinical instructor was and what their philosophy is.
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.)
Very good to know :) Thank you.
I am a typical diabetic at home... I do make sure my finger tips are clean before doing blood sugars since crud can effect the results. But, admittedly, I don't use alcohol preps for my Lantus vial, or when I put a new pen needle on my NovoLog pen. I keep both covered at all times between use. I've done OK....
For patients at the hospital, I always used to use alcohol preps for blood sugars and any injection (sq, IM, IV, etc). With brand new vials I didn't swab if I was the one who flipped the top and had it within sight at all times before using it (and it was a one use vial). I'd been taught that med production was done in massive sterile 'hoods' like the pharmacy uses to prep TPN and special order IV meds...
Specializes in HD, Homecare, Med/Surg, Infectious Disease.
Yes I was also taught that an unopened vial with a cap is considered sterile. I think I am on both sides of the fence. It may not hurt to wipe the top again with an alcohol swab if the person touching it is wearing sterile gloves. Otherwise, the person swabbing the top has contaminated it. Keep in mind that 1: Clean gloves are simply that...clean NOT STERILE. So I would think swabbing it is an added source of contamination because you touched the alcohol swab with your "clean" gloves to do the swabbing. 2: The person swabbing may not have gloves on at all. Unfortunately this is common practice. 3: The outside of the alcohol swab is also not sterile so it is a source of contamination as well. Now if you take the cap off and you observe any debris or uncleanliness then yea I would swab it. Otherwise, I have to say I would not. The top is probably cleaner without swabbing the top with a now unsterile alcohol swab.
Our Pharmacy states the vial tops are not sterile; if you look at the cap after you pop it, it is not air tight so...not sterile.
This is esp true of pop top blood culture bottles. The vial MUST be scrubbed with alcohol and air dried before blood specimen is placed in.
I've worked in 2 states, three hospitals and three dialysis centers. All pharmacists/pharmacy liasons stated the same...top is not sterile, needs to be scrubbed.
]Yes I was also taught that an unopened vial with a cap is considered sterile.[/b] I think I am on both sides of the fence. It may not hurt to wipe the top again with an alcohol swab if the person touching it is wearing sterile gloves. Otherwise the person swabbing the top has contaminated it. Keep in mind that 1: Clean gloves are simply that...clean NOT STERILE. So I would think swabbing it is an added source of contamination because you touched the alcohol swab with your "clean" gloves to do the swabbing. 2: The person swabbing may not have gloves on at all. Unfortunately this is common practice. [b'] 3: The outside of the alcohol swab is also not sterile so it is a source of contamination as well.[/b] Now if you take the cap off and you observe any debris or uncleanliness then yea I would swab it. Otherwise, I have to say I would not. The top is probably cleaner without swabbing the top with a now unsterile alcohol swab.
According to many manufacturers and most pharmacists vial tops are not sterile because they aren't completely sealed. I was also taught that it's easy to touch the top of the vial when removing the cap.
The alcohol swab is sterile. Also, I don't know how you swab, but when I do it, the swab is the only thing that comes in contact with the vial. I hold the swab by one edge and use the rest to clean the vial top. My fingers do not touch the top of the vial at all.
I was taught in school that if you just popped the cap you didn't have to wipe the top with alcohol. However, during my new grad orientation I was told that the tops aren't sterile, regardless if you just popped the top. Out of precaution I began wiping everything with alcohol.
Then I personally discovered just how unsterile those tops can be. I had a patient on compazine and after popping the cap I wiped the top with alcohol and was disgusted by the amount of dirt on the wipe. At first I thought it was a fluke, but it happened on numerous vials. For that reason I am an advocate for wiping everything. Better safe than sorry.
OMG, really? I never swab a new bottle because that's also how I was taught. I think I'm going to start now....
:twocents:you know, we all know what they say about opinions and rectal sphincters: everybody's got one. fact is that if someone's infection is traced back to an injectable from a single-use, multi-use, or injectable port, the lawyer's very first stop is, "what's the standard of care?" and when that lawyer's legal nurse consultant pulls out the thing from the iv nurses association or other such standard (someone quoted them earlier-- sorry i don't have them to hand), that, my friends, is the end of the discussion. if they depose every one of you on the unit and some say yes and some say no, then there is serious down-going gonna happen.:down::down::down:
:down:
gjerstp
9 Posts
I'm an instructor at a nursing school. I personally used NOT to swab new one-use vials. But once I started teaching I cleaned up a lot of my own practices in order to give a good example and follow the practices of my school.
I decided that it's a good thing to carry out such procedures as swabbing everything always between any two accesses because if it's a constant, reliable habit, then you'll never forget. It's similar to identifying your patient every time you do an intervention - of course you know that person well by the middle of the day, and it's not really necessary to check who they are. But you'll never make a istake if you ALWAYS carry out these procedures. Be safe.