Doctor, the nurse, or home care, administering injections is a common daily practice for many medical professionals and carers, (and that’s not including the millions of injections that have taken place due to Covid-19).
Essentially, injections are the fastest and most efficient way of getting a substance into the bloodstream for myriad purposes.
Whether the injection is to treat a medical problem or to vaccinate, intramuscular injections, or simply to numb an area of tissue, proper sanitation techniques need to be consistently applied.
This of course means clean needles, the environment, the hands of the carer, and finally, the injection site.
The latter we will look into today.
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What is the best procedure when cleaning an injection site?
Washing Hands
The first step is to ensure that your hands are properly cleaned your hands with antibacterial soap. Do this under running water so that you can scrub your fingers effectively.
Apply soap for at least 15 seconds and rinse all remnants away with fresh tap water.
A good practice is to turn the faucet off with a clean towel. This helps to prevent recontamination from any pathogens that could be on the faucet.
After this, you immediately put on your gloves.
Site Disinfection
The next step is to clean the injection site with alcohol swabbing. This is the long-standing view that I abide by, (I will explain the opposing view shortly).
Prepping the skin with a saturated 60% to 70% alcohol swab for 30 seconds is the standard approach that is also recommended by World Health Organisation (WHO).
It is advised that you use firm circular motions to apply the alcohol. This is done by targeting the center of the injection site and working outwards to an area approximately 2 inches in diameter.
The solution dries quickly. You can leave the skin to dry for up to 30 seconds so that the alcohol does not seep into the injection puncture, (which would lead to increased patient discomfort).
With the needle prepped and ready and the skin sanitized you can now administer the injection.
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The opposing view
There has been continued debate over recent years whether the practice of alcohol swabbing is effective for reducing infection.
The argument goes that not many patients arrive for their shot with dirty skin.
What can be interpreted as contradictory to their standard advice the WHO and the Public Health Agency of Canada state that if the skin is visibly clean, there’s no need to swab it with alcohol.
One of the reasons swabbing continues, however, is simply the peace of mind it gives the patient. Having the injection area cleaned is part of the “ritual”, it does provide a level of confidence that protocol is being followed and that the patient is in safe hands.
In my opinion, that reason alone should be enough to see alcohol swabbing continue before injection.
References
- “Best infection control practices for intradermal, subcutaneous,
and intramuscular needle injections“, Yvan Hutin, Anja Hauri, Linda Chiarello, Mary Catlin, Barbara Stilwell, Tesfamicael Ghebrehiwet, Julia Garner, & the Members of the Injection Safety Best Practices Development Group. [WHO Link] - “Is skin disinfection before subcutaneous injection necessary? The reasoning of Certified Nurses in Infection Control in Japan”, Yuko Yoshida, Risa Takashima, Rika Yano. January 8, 2021
DOI: https://doi.org/10.1371/journal.pone.0245202 - “Skin-cleaning among hospitalized people who inject drugs: a randomized controlled trial”, Michael D. Stein, Kristina T. Phillips, Debra S. Herman, Julia Keosaian, Catherine Stewart, Bradley J. Anderson, Zoe Weinstein, Jane Liebschutz; 23 August 2020. DOI: https://doi.org/10.1111/add.15236
