Friday, 9 February 2007
Ritualistic Nursing - Pre-Injection Skin Cleansing
"The World Health Organization (WHO) estimates that 12 billion injections are given annually, 5% of which are administered for immunization and 95% for curative purposes. Unsafe injection practices (especially needle and syringe re-use) are commonplace in low-income country health settings, and place both staff and patients at risk of infection with blood-borne viruses (BBVs)."
A fascinating bunch of statistics. But all the literature is clear that reusing and improperly sterilizing are the issues, even in the poorest of developing countries: "Eliminating unnecessary injections is the highest priority in preventing injection-associated infections. However, when intradermal, subcutaneous, or intramuscular injections are medically indicated, best infection control practices include the use of sterile injection equipment, the prevention of contamination of injection equipment and medication, the prevention of needle-stick injuries to the provider, and the prevention of access to used needles."
There's a lot of related literature, and it makes harrowing reading.
But nowhere do I find mention of routine skin cleansing with alcohol for injections (leaving IV aside, here). A few years ago, I read a paper that I cannot now find in Pubmed, that looked at the number of injections per annum in the US (many millions) and reviewed the number of infections that could be firmly linked to skin contamination. Zero.
So why is this routine still applied almost everywhere? OK, the cost and time are small - but it all adds up, and waste is waste.
There are always special cases, of course; patients with diabetes spring to mind as a subset at increased risk. But are they? "Routine skin preparation with alcohol before insulin injection markedly reduces skin bacterial-counts but may not be necessary to prevent infection at the injection sites." ¶ 21:42
A fascinating bunch of statistics. But all the literature is clear that reusing and improperly sterilizing are the issues, even in the poorest of developing countries: "Eliminating unnecessary injections is the highest priority in preventing injection-associated infections. However, when intradermal, subcutaneous, or intramuscular injections are medically indicated, best infection control practices include the use of sterile injection equipment, the prevention of contamination of injection equipment and medication, the prevention of needle-stick injuries to the provider, and the prevention of access to used needles."
There's a lot of related literature, and it makes harrowing reading.
But nowhere do I find mention of routine skin cleansing with alcohol for injections (leaving IV aside, here). A few years ago, I read a paper that I cannot now find in Pubmed, that looked at the number of injections per annum in the US (many millions) and reviewed the number of infections that could be firmly linked to skin contamination. Zero.
So why is this routine still applied almost everywhere? OK, the cost and time are small - but it all adds up, and waste is waste.
There are always special cases, of course; patients with diabetes spring to mind as a subset at increased risk. But are they? "Routine skin preparation with alcohol before insulin injection markedly reduces skin bacterial-counts but may not be necessary to prevent infection at the injection sites." ¶ 21:42
