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

[guest112]

Interesting thread. I really value allnurses.com and look here for information often. I thank all the nurses that post here. Regarding swabbing, I commend all the posts that cite credible source rather than their nursing school instructors or fellow nurses. We need to use evidence-based practice when available. According to the CDC, alcohol wipes do NOT sterilize, they only disinfect. Alcohol in concentrations over 60% kill all vegetative cells, but NOT spores. Next, the process takes time. It took 10 secs to kill many types bacteria. Friction is the mechanism to ensure the alcohol reaches the bacteria since bacteria grow on oils and particles and can form colonies which can protect bacteria in the center. So the 1 swipe, the 0.5 sec, or 3 sec rubs may not be disinfecting properly.

Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

[Testa Rosa, RN]

As the originator of this thread, I want to say a big THANK YOU for ALL your input. As a result of all your answers and links, I now swab everything. It's become habit, even in a code situation. However, I've been criticized for doing this by other nurses and still cannot point to a specific policy within my facility that indicates we are to swab single use vials. I've gotten conflicting answers but as a point of practice I swab everything. Thank you again to all of you who provided input as it does paint a picture of current practice out there in the real world and it does point to a grey area that needs further investigation and refined policy.

[applewhitern, BSN, RN]

I was taught to swab, as they aren't considered sterile. I always swab! It takes so little time to insure the patient's safety.

[Samanthae]

I have always swabbed because that was how I was taught, however the other day one of my friends told me it wasn't necessary, I told her I do just in case something spilled on the vial I would know I did what I could to keep my patients safe. Later that day a vial had broken on several other vials, confirming my processes. It only takes a half a second or two to swab.

[thenightnurse456]

Swab twice

[guest112]

To do this properly, you need to swab for 20 secs, then you need to let it dry. It is the friction action that is important just like in hand washing. I always swab because if you look carefully at the plastic pop tops of the vials you can see that many are not air tight and therefore cannot be sterile.

[boggle, ASN, RN]

"The way we've always done it..." is a dangerous basis for nursing practice.

I think we nurses have been bedside researchers and scientists for decades, but now we finally have easy access to studies that support what we do....and we can cite it too.

I commend you posters who are seeking out the answers from manufacturers and infection control studies. Please share your results with us!

[wolfsavard]

Just looked into this matter to create a clinical pearl for the nurses on my unit. You MUST scrub with alcohol. The caps to not keep the vial tops sterile.

A study was conducted to test the barrier protection of flip-top pharmaceutical vials. After routine handling and routine removal of the dust cover, contaminants were identified on 16% of the tested vials (Hillard et al., 2013). These findings validate and support guidelines and recommendations of aseptic technique in all aspects of medication preparation. Guidance for vial medication handling should consistently emphasize sterile practice, including disinfection of the access diaphragm. Aseptic technique that includes disinfecting the access diaphragm prior to use is recommended by regulatory agencies, pharmaceutical manufacturers, specialty societies, and associations including the Centers for Disease Control (CDC), World Health Organization (WHO), Healthcare Infection Control Practices Advisory Committee (HICPAC), and the Association For Professionals in Infection Control and Epidemiology (APIC).

Here is the reference: Hilliard, J., et al. (2013). Barrier protection capacity of flip-top pharmaceutical vials. Journal of Clinical Anesthesia, 25(3), 177-80.

[BeenThere2012, ASN, RN]

To do this properly, you need to swab for 20 secs, then you need to let it dry. It is the friction action that is important just like in hand washing. I always swab because if you look carefully at the plastic pop tops of the vials you can see that many are not air tight and therefore cannot be sterile.

This is what I was most recently taught and what I do.