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Dear Colleagues,
I have posted this several times on this forum before. I don’t think I should repeat myself in great detail again, so just short comments at this point.
The recommendation to do skin antisepsis only if skin is visibly dirty is baseless. Microorganisms are invisible, that is their very nature. Microorganism counts on skin — even visibly clean — vary dramatically between individuals and between different skin sites. There is absolutely no basis whatsoever for making a distinction — in the form of a “cutoff point” — between visibly clean and dirty skin in terms of swabbing or not swabbing. I should ask a question. You are sitting in front of a patient with darker skin colour wanting to give an injection: When would you decide that the skin is “visibly clean”?
It is correct that alcohol would inactivate vaccines if it would contaminate — in relevant concentrations — vaccines. However, (a) the alcohol is supposed to be dried before inserting the needle, and (b) even if it hasn’t dried, you can calculate this on the following grounds: (i) you take the needle gauge that you would be using (http://en.wikipedia.org/wiki/Needle_gauge_comparison_chart) and use the inner diameter, (ii) you use pi (that mathematical circle number from high school maths) and calculate the surface area of skin, (iii) then you assume a height of 0.1 mm as a thickness of an alcohol film that has not dried (that is probably an overestimate), and then you arrive at an alcohol amount that would be carried under the skin by the needle bore, and this would be in the nanolitre (nL) range (I calculated it once, but forgot exactly how many nanolitres). With an assumed 0.5 mL vaccine, the alcohol percentage would then be something like 0.0001% (if I am not mistaken). That alcohol concentration would never be able to affect any vaccine.
In conclusion, both the recommendations in the Australian Immunization Handbook and in the WHO document follow a severely defective logic.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
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
Thank Marija – that would be great.
Christine Lawson | RN
Quality and Risk Manager | Caboolture Private Hospital
Caboolture Private Hospital
McKean Street, CABOOLTURE QLD 4510
t: 07 5495 9418
e: LawsonC@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au
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Hi Christine,
I have an article from Ireland that I am happy to send you.
Kind Regards
Marija Juraja |Clinical Service Coordinator (CICP) – Infection Prevention & Control Unit|
t: +61 8 8222 7588| p:47757| f: +61 8 8222 6461 | DX: 465432 |e:marija.juraja@health.sa.gov.au
Care Excellence Collaboration Integrity
GERMS CAN KILL…
Thanks guys – I do have this information for immunisations – I was thinking more of in hospital – S/C or IMI narcotics or clexane/heparin.
Christine Lawson | RN
Quality and Risk Manager | Caboolture Private Hospital
Caboolture Private Hospital
McKean Street, CABOOLTURE QLD 4510
t: 07 5495 9418
e: LawsonC@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au
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Hi Christine
The Australian Immunisation Handbook states:
2.2.4 Preparation for vaccine administration
Skin cleaning
Provided the skin is visibly clean, there is no need to wipe it with an antiseptic (e.g. alcohol wipe).3,8 If the immunisation service provider decides to clean the skin, or if the skin is visibly not clean, alcohol and other disinfecting agents must be allowed to dry before vaccine injection (to prevent inactivation of live vaccines and to reduce the likelihood of irritation at the injection site).9
http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook10-2-2
Cheers
Michael
Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Hi all,
Wondering if anyone can guide me to reference/ evidence base re swabbing skin before s/c or imi injection is or is not recommended.
Christine Lawson | RN
Quality and Risk Manager | Caboolture Private Hospital
Caboolture Private Hospital
McKean Street, CABOOLTURE QLD 4510
t: 07 5495 9418
e: LawsonC@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au
[http://www.ramsayhealth.com.au/images/email/RHC-email-2013.jpg]
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