It is widely assumed that the skin has organisms that contaminate it and which might cause pathological transformations when injected into the body through the injection of a needle. With this assumption as basis patients, nurses, trainee doctors and medical students are trained to prepare the skin before injecting it through cleansing with a kind of antiseptic to keep away any infections at the site of injection. Alcohol swab that is comprised of 70% of isopropyl has been used since the 19th century as the oldest and most highly effective antiseptic for the preparation of the skin just before an operation. Alcohol has no activity as far as fungal spores are concerned but, it destroys most of the vegetative bacteria (Williums et al., 298).
I once encountered a patient who asked about the practice of skin disinfection prior to administrating an intramuscular injection. The patient before receiving his injection asked me not to use alcohol swab because it caused a sting on his skin every time. According to the patient, alcohol evaporates so rapidly, hence when utilized a little bit of it may be transported throughout the body by the skin with the injection needle hence bringing about an uncomfortable stinging sensation.
The skin around the infected area was thoroughly swabbed for about thirty seconds with 70% isopropyl and given time to dry for another thirty seconds before injection. I analyzed the injection area after a period of six hours through the help of a microscope. An observer who was independent such as the family doctor and who was unaware of the status of the swab was not available at the moment. For analysis purpose assessment was done on the formations of abscess, fever, swelling, pain and erythma. I also did a follow up on the area of injection noting any forms of tenderness, redness or any other signs that do not seem to be normal in the injection area.Then in the next six hour period the effect of no skin preparation before injection and the effect of skin preparation that is routine using alcohol swab through the analysis of CFU- the skin bacterial colony forming units per mil.
At the beginning of the experiment I made sure that the patients had co morbidity or skin disease that is heart valve or immune-suppressed disease. It was from the area of injection that I took a swab for culture going by the instructions by the microbiologist consultant of the hospital just before and after getting the alcohol swab wiping from the participant to assess the effects of using 70% isopropyl alcohol swab for skin preparation pathologically.
Before wiping it with 70% isopropyl alcohol swab, the first culture was collected using a dry cotton swab that was sterilized directly from the injection site. Then for about thirty seconds, I scrubbed the site with an alcohol swab using some moderate pressure then it was given some extra thirty seconds to dry before being given another injection. Prior to being scrubbed with an alcohol swab, the second culture swab was done after giving the injection. Before statistical analysis I made sure I first counted the CFU of the volunteer.
The fungal or viable bacterial numbers are all measured using the CFU- colony-forming unit in microbiology. The CFU is responsible for measuring the viable cells, while the direct microscopic count measures all the living and dead cells. Generally it is utilized for the measurement of the number of microorganisms present on or in a sample or surface.
For the experiment to take place I had to seek approval from the hospital’s ethics committee. As for the participant he simply gave informed consent. I processed the data on SPSS-16 package and entered it into a spreadsheet. In order to summarize basic demographic data, I made use of descriptive analysis, Bacterial (CFU/ml) colonies forming units were counted from all the cultures that came out positive and statistically analyzed. Unless noted otherwise, data is represented as Mean + SD. The variance between the data of the two groups was analyzed by student’s t-test.
The study I conducted illustrated the fact that preparation of the skin using an alcohol swab kills 47% of bacteria of the skin at the site. Lack of skin preparation with an alcohol swab just before an injection, did not show us any clinical illustrative signs. It is impossible to comment on the removal of skin bacteria mechanically as we did not compare placebo wipe with alcohol wipe.
The skin is the largest organ of the body, theoretically and its purpose is to protect against infection, injury, light and heat as well as the storage of fats and water and the regulation of body temperature. The skin is a sensory organ capable of preventing the entry of bacteria and loss of water (Hutin et al., 493). Many organisms reside on the skin and commence on the surface. In the study we conducted we mainly found the organism staphylococcus epidermidis with the number of CFU ranging from 2-12 CFU in an unclean skin site compared to a 2-6 CFU in a thoroughly clean skin surface. When I consider the small area that is needed for an injection, it is clear that the number of injected bacteria in a site that is not clean is much lower than what is needed for the formation of the pass. Different controlled studies showing infection risks linked to injections reveal no real signs on both patient groups of those who had not or had had skin preparation.
Digging into secondary research to support my findings I found in a study of over a period of 20 weeks the famous Fleming had observed thirteen thousand insulin injections without and with skin preparation using alcohol and in both groups he did not find any infection signs at the injected site (Pratt, Hoffman and Robb, 18). Similarly, in a period of six years Dann (96) monitored over five thousand injections undertaken using all routes without any skin preparation processes and he did not find any sign of infection on the injection site of the skin. McCarthy conducted a study on fifty patients whom he had used insulin on. He did a comparison of six hundred injections taken separately without skin preparation, six hundred with cotton soaked in tap water and six hundred with alcohol wipe on the three quarters of the abdomen. He came up with the conclusion that none of the patients he tested underwent any injection site complications from the three methods (Binswanger et al., 579).
Studies in microbiology do not indicate that the use of antiseptic on the skin before intramuscular, intradermal and subcutaneous injections lowers the risk of infections. Felig and Kolvisto measured flora in skin bacteria after wiping for five seconds with 70% isopropyl alcohol swab and they discovered a decrease in the count of bacteria by 82-91%. During an observation period of 3-5 months in this same study the comparison of 1700 insulin injections done without any skin preparation and with skin preparation using an alcohol swab showed no systemic or local infection at all (Williums et al, 300).
In a different study a number of seventeen patients reused a total of one hundred and eleven insulin syringes for a record two thousand three hundred and sixty three times and there were no signs of infection on the site of injection. Just like the piercing of contaminated skin, infections are more or less likely to arise from infected injected solutions and infected needles and syringes. With skin cleansing the danger of drug users getting skin infections would be much lower, however the virulence and numbers introduced on skin bacteria is smaller than the minimum infectious dose of the formation of pus.
What I found is that there are studies that warn the use of a cleaning material for the alcohol swab could leave traces on the needle causing irritation to the site of the injected area. While other research shows that the site of injection should be cleaned in order to reduce the risk of getting an infection. Lodophors and ethyl alcohol are some of the commonest solutions used for the preparation of the skin before an injection (Williums et al, 300). Researchers view that the ongoing use of an antiseptic cannot work on time as what is normally expected in general practice that is five seconds to be precise and this is not a guarantee for complete sterility. The best practice according to scientists would be to clean the skin site thoroughly before injection in order to avoid the formation of an infection in the skin flora of the patient (Williums et al, 300).
For the sake of deducing the presence of pathogens swabbing the site of injection with 70% saturated alcohol swab for thirty seconds and giving the area an extra thirty seconds to dry is appropriate. The time given for the site to dry sometimes does not prevent the stinging effect of the alcohol to the tissue upon needle entry. However, nurses always put into consideration the legal implications in medicine and always choose to abide by the guidelines put down by the employer/health authority as far as skin cleansing before injection is concerned. It would be very hard to defend a case that came about due to the injection of a patient’s skin without performing any cleansing of the area. The organisms that cause any abscesses at the intramuscular site are pathogenic in nature. It is, however evident that in the last few years the debate on whether it is important to remove these pathogens from the skin just before an injection something that will go on for a long time.
Despite the many research findings done over the years in a bid to discover the basis for cleansing of the skin just before the administration of an injection that is intramuscular and it this position that has left nurses in a haze as to whether this routine practice should be performed or not. As much as the literature on this issue is not definite, many communities, individuals and institutions all over the world continue to seriously advocate that it is important for the practice of cleansing of the injection site to continue on.
Therefore, preparing a person’s skin for injection is not necessary. Hence the preparation of the skin with alcohol is not really a requirement. Not preparing skin for an injection when not necessary saves money and time and helps reduce the pain linked with the injection of alcohol that is non evaporated on the skin.
Conclusion
In this study the concept that has to do with skin preparation before an injection by swabbing it with alcohol as a measure for use of an antiseptic, is what was measured and this commonly used method was found to be inadequate as a method for protecting against infection.
The study also shows that as much as there was a huge reduction in the skin, floral bacteria, there was no huge difference among the systemic or local effects and the clinical signs without or with the preparation of the skin using an alcohol swab before subcutaneous, intradermal and intramuscular injections. This study and its findings may be used as a tool for the implementation and development of policies by the local creators of policies in the spirit of preventing the wiping of skin with an alcohol swab just before the administration of an injection. This study will also play a big role in making sure money and time is saved by not performing this practice which from practice has been deemed to be one that is not necessary. And finally, the study shows the importance of using procedures that are precise and at the same time maintaining hygiene.
Work Cited
Binswanger, I.A, Kral, A.H, Bluthenthal, R.N, Rybold DJ, et al. High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco. Clinical Infectious Diseases 2000; 30(3):579-81.
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
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.
Williums, R., Blowers, R., Garrod, L.P, Shooter,RA. Hospital infection. Causes and prevention.
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