Why do nurses use the same alcohol swab over and over?

I know, this may come as a surprise to all of you, but the truth is, I have seen many nurses (even those highly trained and specialized) both in hospitals and outpatient settings, use the same alcohol swab over and over.

Imagine this scenario where a nurse is ready to withdraw medication from several vials. The nurse rips open a swab, then removes the swab from the package using the thumb and forefinger, literally touching the entire surface and both sides of the swab, then proceeds to disinfect the top of one vial. Then using the same swab, the nurse proceeds to disinfect the top of the next vial, and repeats the same until all vials are disinfected, still using the same swab. The swab is then laid on the work surface, and if additional disinfection of the vial is required, the nurse picks up the same swab and proceeds to use it again. The same observation is true when disinfecting Y-sites, connection hubs or needleless connectors attached to vascular access devices. Rip open an alcohol swab, pick up with thumb/forefinger, disinfect hub, then either lay swab on surface or disinfect another hub with same swab. Why do nurses re-use alcohol swabs?

When brought to their attention and nurses are asked – why are you re-using the alcohol swab? Often, I get a blank stare or I get this..“what do you mean”look, and I don’t get an answer. Sometimes I get this answer, “its alcohol, dummy!” or “it’s still wet”. I think back to my nursing school training and I tried to recall what my Fundamentals instructor told us about how to use alcohol swabs. I honestly don’t remember what we were told, whether or not to reuse, or use till dry…..maybe I skipped school that day.

I can’t find evidence based research about re-using alcohol swabs. The fact is that an alcohol swab (aka alcohol prep pad) contains 70% Isopropyl Alcohol and is sterile while in the package. When removed, we need to take great care not to contaminate it with our fingers before we even use it for disinfection. Discard after one use, even if the alcohol swab is still dripping wet. When disinfecting several vials, use one alcohol swab per vial; don’t share alcohol swabs between the vials. I am aware that there are non-sterile alcohol prep pads available in the market, often used by diabetic patients for insulin injections. If selected to be used for disinfection, discard after use. Alcohol swabs are inexpensive and always available. Let’s put this in perspective, if you are the patient, do you want your nurse re-using alcohol swabs on you?

So next time you are getting ready to open an alcohol swab, will you remember hold the swab properly and not to re-use?