Swab All Vials With Alcohol

James J. Lamberg, DO; Lisa J. Yoo, DO, MS

To the Editor

The recent Letter to the Editor titled “Reader Raises Two Propofol Concerns” suggests that providers routinely swab propofol and Diprivan® vials prior to administration. A table was provided comparing manufacturer recommendations for alcohol disinfection of the vial stopper prior to drawing the medication. There have been several articles on this topic, with some defining the practice as unnecessary,1,2 and others reporting contamination risks.3

However, the American Society of Anesthesiologists recommends that an alcohol swab be used for vial rubber septums as well as for the outside of glass ampules.4 The Center for Disease Control also recommends that all rubber septums be disinfected with alcohol prior to drawing medication.5,6 Thus for patient safety, we believe that providers should routinely swab all rubber septums on medication vials as well as the outside of non-sterile glass ampules prior to accessing them.

James J. Lamberg, DO
Lisa J. Yoo, DO, MS
Hershey, PA


References

  1. Buckley T, Dudley SM, Donowitz LG. Defining unnecessary disinfection procedures for single-dose and multiple-dose vials. Am J Crit Care 1994;3:448-51.
  2. Sheth NK, Post GT, Wisniewski TR, Uttech BV. Multidose vials versus single-dose vials: a study in sterility and cost-effectiveness. J Clin Microbiol 1983;17:377-9.
  3. Nogler-Semenitz E, Lass-Flörl C, Nogler M, Speer G, Dierich MP. Bacterial contamination of solutions for parenteral administration for single- and multiple-dose vials after multiple use in the hospital. Wien Med Wochenschr 2007;157:398-401.
  4. Recommendations for infection control for the practice of anesthesiology, 3rd Ed. ASA Committee on Occupational Health Task Force on Infection Control, 2011. Available at:
    http://www.asahq.org/~/media/For%20Members/About%20ASA/ASA%20 Committees/Recommendations%20for%20Infection%20Control%20for% 20the%20Practice%20of%20Anesthesiology.ashx. Accessed June 1, 2012.
  5. Siegel JD, Rhinehart E, Jackson M, Chiarello L, the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Available at: www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf. Accessed June 1, 2012.
  6. Injection safety: Medication preparation questions. center for disease control and prevention. Available at: http://www.cdc.gov/injectionsafety/providers/provider_faqs_med-prep.html. Accessed June 1, 2012.