Skin disinfection and its efficacy before administering injections

Abstract

The need to disinfect a patient's skin before subcutaneous or intramuscular injection is a much debated practice. Guidance on this issue varies between NHS organisations that provide primary and secondary care. However, with patients being increasingly concerned with healthcare-associated infections, a general consensus needs to be reached whereby this practice is either rejected or made mandatory.

The economics of global COVID vaccine administration during a pandemic – Why continue skin alcohol preparation as a costly but ineffective practice?

“…Skin preparation by alcohol swabbing, which persists as standard practice for administering vaccines and self-injection of therapeutics in many regions worldwide, is simply not evidence-based and is likely to be unnecessary [11] , [12] . Healthcare providers in the United States are taught—and a recent check among the major U.S. pharmacy chains confirms—a protocol of wiping the skin for 30 s with an individual alcohol wipe and letting it dry for 30 s. Incomplete drying of skin before needle injection may introduce alcohol into the tissue and consequently increase the level of injection-associated pain [13] . We estimate that skin preparation adds roughly 90 s to each injection, including vaccinations.…”

“…Healthcare providers in the United States are taught—and a recent check among the major U.S. pharmacy chains confirms—a protocol of wiping the skin for 30 s with an individual alcohol wipe and letting it dry for 30 s. Incomplete drying of skin before needle injection may introduce alcohol into the tissue and consequently increase the level of injection-associated pain [13] . We estimate that skin preparation adds roughly 90 s to each injection, including vaccinations.…”

Magnitude and factors associated with injection site infections among underfives in a district hospital, northern Tanzania

“…Intramuscular injections which are mainly administered for immunization purposes account for an estimate of 12 billion injections annually throughout the world (Dann, 1969). Unsafe injections (administered under unsterile environment) cause about 13 million early deaths, loss of 26 million years of life and an annual burden of 535 million US dollars as direct medical cost (Gittens & Bunnell, 2009). Contaminated syringes, dirty skin and skin normal flora are the major factors that contribute to the burden of injection site infections (Pittet et al, 2006;Gittens & Bunnell, 2009).…”

“…Unsafe injections (administered under unsterile environment) cause about 13 million early deaths, loss of 26 million years of life and an annual burden of 535 million US dollars as direct medical cost (Gittens & Bunnell, 2009). Contaminated syringes, dirty skin and skin normal flora are the major factors that contribute to the burden of injection site infections (Pittet et al, 2006;Gittens & Bunnell, 2009). Skin preparation by rubbing with antiseptic such as 70% alcohol is one of the recommended procedure for sterilizations of the injection site (Hutin et al, 2003;Gittens & Bunnell, 2009).…”

“…Contaminated syringes, dirty skin and skin normal flora are the major factors that contribute to the burden of injection site infections (Pittet et al, 2006;Gittens & Bunnell, 2009). Skin preparation by rubbing with antiseptic such as 70% alcohol is one of the recommended procedure for sterilizations of the injection site (Hutin et al, 2003;Gittens & Bunnell, 2009). However, over the past 30 years Safe Injection Global Network Research (SIGNR) has questioned the value of skin preparation prior to injections (Cocoman & Murray, 2007).…”