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When prepping a catheter site, do I need to use Alcohol swabs before using ExCel_AP^®?

No.  ExCel_AP^® contains both isopropyl alcohol (72%) and Povidone-Iodine (PVP-I; 7.5%) in concentrations individually considered by the FDA to be safe and effective for preparation of the skin prior to surgery and injection, and has been shown to meet the FDA’s requirements for this indication – see ExCel_AP Technical Bulletin.

However, while it has been shown to be more effective than alcohol alone (see ExCel_AP Technical Bulletin), contrary to common understanding, alcohol is actually quite persistent – not because it remains on the skin in contact with whatever bacteria are present, but instead, because…

1. It kills more microorganisms than any other antiseptic (including CHG and PVP-I). According to CDC’s Guideline for the Prevention of Surgical Site Infections, it’s the most effective, fast acting single active ingredient.
2. It renders those organisms that survive exposure to it extremely limited in their ability to reproduce.  As illustrated in the table below taken from FDA’s Microbiology Review of ChloraPrep’s New Drug Application (see http://www.fda.gov/cder/foi/nda/2000/20-832_CHLORAPREP%20ONE-STEP%20ANTISEPTIC_microbr.pdf), alcohol is as persistent as ChloraPrep for 24 hours.

However, because the initial kill and persistence of any antiseptic regimen is dependent on the duration of time the skin is in contact with the antiseptic products involved (see Art, JAVA), the use of alcohol swabs prior to the use of ExCel_AP^® will add to the overall log reductions experienced.

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