I am of the opinion that it is inappropriate to experiment with patients lives leave alone write about it. Most of the research carried however has been carried out on patients. Experimenting with patients is dangerous as the consequences could be dire and unbearable. It is not an accepted code of conduct in the medical practice.
It is widely assumed that the skin is highly contaminated and this contamination may be a major risk to the body through injections. This assumption leads to the practice of skin preparation prior to injections. The mode of skin preparation however differs amongst different practitioners. Whether or not to wipe with alcohol remains one the most ambiguous topics in the health sector. All researchers however agree on one thing, that the skin should be clean prior injection. The cleansing agent however remains an issue of concern among the researchers. Some are of the opinion that alcohol is not a necessary cleanser prior injection while others are of the opinion that there is need to wipe with alcohol prior injection. I wish to explore on these two views and give my informed opinion.
It is not necessary to swab a patient’s skin with alcohol prior to injection. Use of alcohol is not sufficient to remove a patient’s skin flora because the contact time is very minimal. Infection risk is thus very low even when injection is done without preparing the skin. Dangerous skin preparation or one that is not safe should be avoided as it may harm the patient. Thus, in the case of swabbing the swabbing element should be clean and should not be exposed to germs. The swab should not be used after injection as it may end up causing irritation as some of it may be left behind. Alcohol swab has commonly been used. It contains 70% isopropyl. The World Health Organization however does not recommend swabbing if the skin is clean. Alcohol destroys vegetative bacteria but is not involved in fungal spores ( Williams et al.,298).Use of soap and water is thus considered good enough before injection. The hands however must be dry in cases of vaccine administration to prevent its inactivation. This was a guidance by ‘The American Centre for Disease Control and Prevention (2002)’ I would thus not be altering the set practice in case I don’t clean with alcohol prior to injection.
The key consideration for me would be my working environment, the tools of work and the cleanliness of the area I am about to inject. A study conducted on 13 diabetic people and showed that alcohol reduced bacteria counts by 82% and above. However, the disinfection does not prevent infection at the area injected thus not necessary. Questions still arise on whether WHO recommendations were evidence based or just consensus and use of theoretical rationale but the fact remains that there are no infection cases related to the lack of its use. The needle in use should be sterile to avoid infection cases. I strongly feel that the use of alcohol prior to injection may have been aimed at fighting infections without due consideration to their source which in most cases come from unsterilized needles (O'Grady et al., 52).
I am thus in a position to explain to patients why there is no need of using a disinfectant before an injection. This will in turn save both time and money as so much money goes into buying alcohol for disinfectant purposes. The practice of not using alcohol has been in practice in UK hospitals and there are no cases of infections reported. This is further proof that using alcohol prior to injections is not a necessary precaution (Hoffman. 2001). They also emphasize on cleanliness of the area of infection prior to injection. The packaging of the syringe should be considered to avoid infections. A new syringe must always be used. If torn, the needle should be discarded. The area or location of infection should also be free from body fluid and blood. Used needles should also be discarded in inaccessible areas as they may be a threat to the well being of others and cause infections. The well being of the administrator should also be considered. Use of alcohol prior injection cannot be said to prevent the above given practices at all.
Most of burden in prevention of bacterial infection lies in the hands of the administrator. For example in cases of excessive bleeding, use of gloves may be necessary (O'Grady et al., 55). The hygiene of the person administering injection should also be considered and varied between injections. I am however of the opinion that more research should be carried out for the vulnerable groups such as the old and the areas of injection. The area of injection too is another consideration on whether to use alcohol or not to. The area of injection is very small which leads me to the conclusion that it cannot lead to the formation of puss. A study by Fleming further revealed no infection in thirteen thousand injections made with insulin either with or without the use of alcohol (Pratt, Hoffman and Robb, 18). Dann (96) is also of the same opinion through administration of injections numbering to five thousand and above.
As a nurse however, I wish to put it across that though I am of the opinion that there is no use swabbing with alcohol prior to injection, I would consider the legal obligations and implications. The rules and regulations of my employer would be strictly adhered to and thus I would use alcohol prior to injection if that is what they stipulate. It is also very hard to deal with any case of negligence or infection because of not wiping with alcohol before injection. The debate and question remains on whether there is need to remove the pathogens that alcohol eliminates when used prior to injections. Some of the alcohol too may not evaporate and thus may cause pain upon administration of an injection.
The use of soap and water cannot be overemphasized. All researchers agree to the fact that the area of injection should be thoroughly washed especially if it was soiled. All manner of infections should thus be avoided so that no un- informed evidence relating the infections to lack of alcohol use prior to injections arise.
Current practices and the patients’ concern is an area of consideration. Key to note is that communication between patients and the nurses or one administering injection for instance should be free and open. A patient has a right to ask questions regarding their health but no right to treat themselves or prescribe drugs. A patient for instance may enquire on whether they ought to use alcohol swab for instance before injection. It is the sole duty of the nurse to inform the patient on the pros and cons of the practice and advice them accordingly. The code of conduct of a practitioner too should be such that the interests of the patient are given the first priority. The hygiene of the one administering injection for instance should be considered. It is also important to know that not all practices have a research basis and that no one has a monopoly of knowledge. Thus, patients can truly reveal who one truly is in real sense. In my case, a patient asked me about the practice of skin disinfection before administering an injection.
The patient asked me not to use alcohol swab as it caused a sting on his skin any time he had an injection. The way I handled the scenario was not right as experimenting with a patient is not acceptable in our practice. I indeed should have consulted either other doctors or the management to know if indeed I was doing the right thing. I should also have used my previous knowledge and the research further available to know whether to use alcohol prior to injection. It is not acceptable that a practitioner heeds to the patient’s instructions in his line of duty. Further experimenting with the patient made the matter even worse. The fact that I wrote on experiments done on a patient was inappropriate and not acceptable. O the patients concerns, 54% are not dealt with by physicians. Another study shows that physicians interrupted their patients on average within 18 seconds.
That goes further to prove that communication is surely a major issue. I believing that listening is a major part of the communication process. Most complaints by patients too are communication related and not about competence. Relay of information to patients and provision of feedback is also a major issue of concern (O'Grady et al., 49). In communication too, it has been shown that doctors use a language that is not clear at all to the patients and do not bother to explain. There is a general assumption by practitioners about the information needed by patients both in quantity and in type. This misconception has been a major barrier and impediment to the patients acquiring information. This makes the patients anxious and dissatisfied. The physician must thus adhere to the very best practices. It however does not recommend that the skin be swabbed with antiseptics.
Emphasis in communication with the patient must be made on the need to thoroughly wash hands with water and soap and not just major on alcohol use prior to injection. I suppose this is what I should have emphasized on when dealing with my patient. The skin being overly exposed yet the largest organ in the body is very prone to infections. Whether to use or not use alcohol before injection may altogether come down to economic loss and time lost in the practice. There are no side effects to its use in swabbing and thus those who are of the opinion that it should be used are not prohibited from doing so. There is also no known evidence that failure to wipe with alcohol causes infection. Perhaps the area of consideration should be on when the alcohol should be swabbed and the state of the swabbing appliance. It is thus quite evident that what should therefore be observed is the practice conduct and use of the rules governing different organizations.
Publications and experiments done on patients are also not very appropriate. I suppose that the practice of wiping with alcohol is just mental and a norm that has continued to be widely used. Those who still use it have no scientific reason as to why they do it since the number of pathogens it kills cannot cause pus. To them it is more of a practice to prepare the skin for injection. While the role of alcohol in killing pathogens cannot be wished away, the time and resources attributed to it are high and can be minimized. It also poses a threat if not well administered and the skin left wet as it causes irritation (Seifert et al., 20). With this in mind, I suppose that with or without the use of alcohol what is most important is for practitioners to carry out the best practices possible.
An example is on hygiene of oneself, appliances in use, and the environment where injection is to take place. The health sector should also conduct various researches and give a clear position on whether or not to use alcohol prior to injection. This will go a long way in boosting the patients’ confidence in the health sector worldwide. This confidence is very crucial especially when dealing with one’s health without which the health sector cannot thrive. Information should also not just be given to patients but the explanations thereof as patients are always eager to know the risks associated with various practices such as the use of alcohol prior to injections.
Works cited
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Dann,T.C. Routine skin preparation before injection; an unnecessary procedure. Lancet 2009; 2 (7611): 96-8
Hutin, Y,Hauri, A, Chiarello L, Catlin, M.,et al. Injection Safety Best Practices Development Group. Best infection control practices for intradermal, subcutaneous and intramuscular needle injections. Bull World Health Organ, 2003;81(7):491-500.
O'Grady, Naomi P. Guidelines for the Prevention of Intravascular Catheter-Related Infections. Atlanta, GA: Centers for Disease Control and Prevention, 2002. 47-59.
Pratt, R.J, Hoffman PN, Robb FF.The need, for skin preparation prior to injection. Point-Counter point. British Journal of Infectious Control 2005; 6(4): 18-20
Seifert, Harald, Bernd Jansen, and Barry Farr. Catheter-related Infections, Second Edition. Hoboken: Taylor and Francis, 2013. 10-26.
Williums, R., Blowers, Garrod, L.P, Shooter,RA. Hospital infection.Causes and prevention. London: Lloyd-Luke, 2000; 298-335.
