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Dear Amanda, dear Julie,
I refer to a few prior postings that I made on this forum on this topic. I don’t want to repeat this in detail (but certainly can do so if this is required), but the evidence assessments (both in the Immunisation Handbook and of the WHO – have not seen the Joanna Briggs one) leading to the recommendation to NOT swab before ANY type of infections (including deep intramuscular, intraarticular, etc., etc.) are seriously flawed. Just as a small example, there is no factual or evidence-based or microbiological basis for the distinction between visibly clean and dirty skin. Visibly clean skin can harbour very high microorganism numbers.
What needs to be recognised is that the physiology of (and pathophysiology of infections caused by) the different types of injections is fundamentally different. The decision to not swab before very superficial (subcutaneous or intracutaneous) infections may be justifiable on the basis that these are anatomically very superficial and any infections easily treatable, but this cannot be generalized to any types of injections.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Senior Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387
Hi Amanda
We don’t clean with an alcohol wipe prior to any injections, including immunisations unless the area of skin is visibly dirty. You could have a look at The Australian Immunisation Handbook which confirms this for vaccinations. You might also want to look at the WHO Best Practices for Injections policy & the Joanna Briggs Institute website.
Kind regards
Julie
Julie Baile I Clinical Nurse Infection Prevention & Management
South Metropolitan Health Service Fiona Stanley Hospital
Level Ground, Block B, 11 Robin Warren Drive, MURDOCH WA 6150
Postal Address: Locked Bag 100, PALMYRA DC WA 6961
T: 6152 8915
E: julie.baile@health.wa.gov.au
http://www.southmetropolitan.health.wa.gov.au
http://www.fsh.health.wa.gov.au
Hi All,
I am just looking at what everybody’s current practice is when giving insulin or clexane injections.
Do you swab prior to injection or not? And does anybody have any of the latest evidence regarding this?
Thanks
Amanda
Amanda Hill
Staff Development Nurse – Palliative Care
Clinical Nurse – Infection Prevention & Control
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