Contaminated Alcohol Swabs: One More Reason to Use Disinfection Cap

There were already real concerns about the use of alcohol swabs to disinfect needleless IV connectors. Now here comes another one: The pads themselves can be a source of potentially deadly contamination.

The FDA announced Jan. 5 that Triad Group, a Hartland, Wis. manufacturer, was voluntarily recalling all lots of its alcohol prep pads, alcohol swabs, and alcohol swab sticks because they might be contaminated with the organism Bacillus cereus. Use of any of these products, if contaminated, “could lead to life-threatening infections, especially in at-risk populations, including immune-suppressed and surgical patients,” the FDA’s press release said.

Triad products are widely used in the healthcare marketplace, not just under the Triad name but also as private-labeled products for corporate customers. In addition, various companies include them in their medical product packages – which is why corporations such as Bayer and Genentech are informing their customers about the recall and warning them not to use the Triad alcohol products packaged with their medicines.

Even before this brouhaha, many infection control professionals worried about the use of alcohol swabs to disinfect IV connectors. Hospitals generally require that connectors be disinfected before a clinician accesses an IV line for a blood draw or to inject nutrients or medication. The traditional method involves scrubbing the port with an alcohol swab for 10-15 seconds and then waiting for the alcohol to dry before accessing the line.

Even if the swabs are sterile, this somewhat complicated, time-consuming method is prone to variance and noncompliance, which increases the chances of a potentially fatal bloodstream infection.

“Alcohol prep pads are only as good as the person using them. Prep pads are rarely used long enough or with enough friction to cover all surface areas,” says Nancy Moureau, vascular access specialist with PICC Excellence (Hartwell, Ga.)

The best way to avoid the pitfalls of alcohol scrubbing – not to mention contaminated swabs – is to use a disinfection cap such as SwabCap (Excelsior Medical, a client of Dowling & Dennis). SwabCap twists onto the threads of the connector. Its patent-pending design keeps the entire port bathed in alcohol, an ideal disinfection scenario.

Because it is left on between line accesses, it also protects against contamination of the port during that time, something that even meticulous scrubbing can’t do. Variation in technique – a recognized source of infection risk with alcohol pads — is virtually impossible, because the cap twists on one way, like a nut onto a bolt. Compliance is simple to verify. If the bright orange cap is attached to the port, compliance has occurred. No wonder we’ve seen bloodstream infection rates plummet at one hospital after another when they adopt the device.

Hospitals that use alcohol swabs to scrub connectors are busy emptying their shelves of Triad alcohol products if they stocked them. But they still have to fret about variation in technique, noncompliance with the alcohol-pad protocol, and contamination between line accesses.

Hospitals that use disinfection caps like SwabCap, by comparison, know they have an extra measure of protection and disinfection.

Patient Safety Gets a Certification Program — At Last

More than a decade after patient safety hit the national agenda with the publication of the Institute of Medicine’s “To Err Is Human” report, someone is finally putting together a certification program for professionals involved in ensuring patient safety.

The leading group in this field, the National Patient Safety Foundation (NPSF), has just launched the certification program. It’s designed to standardize a curriculum, elevate the profession and share best practices.

“Patient safety is a top priority for our healthcare system,” said Dr. Lucian L. Leape, chair of the Lucian Leape Institute at NPSF. “But we will not be able to truly move the needle until those who are involved in the practice have the knowledge base necessary to do the job. The certification program is an essential element in that quest.”

Dr. David Shulkin attempted as far back as the late 1990s to highlight the profession through creation of the Patient Safety Officers Society. PSOS got some early traction but hasn’t been active for several years. Dr. Shulkin is now president of Morristown (N.J.) Memorial Hospital and vice president of its parent, Atlantic Health.

This time around, NPSF reports, membership in the American Society of Professionals in Patient Safety is open to professionals whose primary responsibility is patient safety as well as others across the healthcare disciplines.

Our view: The patient safety field represents the essential nexus of numerous healthcare fields, and NPSF’s new initiative represents a major step forward in better protecting patients. More details at