Re: RE; Alcohol swab before injections

[Claire Rickard]

in fact, I have quite a nice bruise the size of a 5c piece after my flu
needle, which bears out my theory that supposed IM injections can be
exposed directly to the bloodstream quite nicely! (although I would rather
they didn’t)

Best regards, Claire

*Professor Claire Rickard RN PhD*

c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research | Intravascular Access Device Research Group | NHMRC Centre
of Research Excellence in Nursing | Centre for Health Practice
Innovation | Griffith
Health Institute | Griffith University

Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
Hospital | The Prince Charles Hospital

P.S. Research frequently takes me off campus. Please contact Jenny Chan,
School Secretary 3735 5406 or *j.chan@griffith.edu.au*
with any urgent enquiries.

On 25 March 2013 12:48, Claire Rickard wrote:

> True enough Michael…although all sorts of tiny vessels lie within the
> subcutaneous and muscle tissue…who’s to say we are not injecting directly
> into some of these when we gve an IM/SC?
>
> As you say, better to err on the side of caution since the consequences
> are so catastrophic…as your cost-benefit analysis bears out 🙂
>
> Best regards, Claire
>
> *Professor Claire Rickard RN PhD*
>
> c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
> IVAD_Research | Intravascular Access Device Research Group | NHMRC Centre
> of Research Excellence in Nursing | Centre for Health Practice Innovation
> | Griffith Health Institute | Griffith University
>
> Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
> Hospital | The Prince Charles Hospital
>
> P.S. Research frequently takes me off campus. Please contact Jenny Chan,
> School Secretary 3735 5406 or *j.chan@griffith.edu.au*
> with any urgent enquiries.
>
>
> On 25 March 2013 12:17, Michael Wishart wrote:
>
>> Hi Claire****
>>
>> ** **
>>
>> I, too, agree with Matthias, but I do not think your comparison with IV
>> access is correct. Giving a sub-cut or IM injection has a much lesser risk
>> of infective complications than any direct access to the blood stream (such
>> as IV access or phlebotomy, for example). In my own practice I currently
>> still use alcohol swabs prior to IM vaccination as it is quick, cheap and
>> not worth the potential infective risk (which is yet to be well quantified
>> as pointed out by Matthias).****
>>
>> ** **
>>
>> If patients are self-injecting (either sub-cut or IM), then the risk from
>> auto-inoculation with their own flora may be even lower (viz
>> self-catheterisation guidelines), so I would have no issues with teaching
>> patients not to swab their own skin prior to a simple injection (as long as
>> they were not directly injecting into a vein or device, though). The
>> evidence supporting this is also pretty scant, though.****
>>
>> ** **
>>
>> 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****
>>
>> Please consider the environment before printing this email****
>>
>> ** **
>>
>> ** **
>>
>> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
>> Behalf Of *Claire Rickard
>> *Sent:* Monday, 25 March 2013 11:42 AM
>> *To:* AICALIST@AICALIST.ORG.AU
>> *Subject:* Re: RE; Alcohol swab before injections****
>>
>> ** **
>>
>> I completely agree with you Matthias.****
>>
>> ****
>>
>> With injections into IV ports we are now encouraged to “scrub the hub”
>> for 30 seconds with either isopropyl alchol or alcoholic chlrohexidine etc!
>> ****
>>
>> ****
>>
>> Yet for the skin, which is nice and warm and moist – capable of
>> supporting much higher microbe counts than a dry cool rubber bung, we use
>> nothing…bizarre!!!
>> ****
>>
>>
>> Best regards, Claire
>>
>> *Professor Claire Rickard RN PhD*
>>
>> c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype:
>> clairexm1 | Twitter: IVAD_Research | Intravascular Access Device Research
>> Group | NHMRC Centre of Research Excellence in Nursing | Centre for
>> Health Practice Innovation | Griffith Health Institute | Griffith University
>> ****
>>
>> ****
>>
>> Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
>> Hospital | The Prince Charles Hospital
>>
>> P.S. Research frequently takes me off campus. Please contact Jenny Chan,
>> School Secretary 3735 5406 or j.chan@griffith.edu.au with any urgent
>> enquiries.****
>>
>> ** **
>>
>> On 25 March 2013 11:29, Matthias Maiwald (KKH) > matthias.maiwald@kkh.com.sg> wrote:****
>>
>> Dear Franciska, ****
>>
>> ****
>>
>> Not sure about clexane and insulin (s.c. injections), but I have looked
>> in some detail into the current Australian recommendations concerning
>> vaccinations. Most vaccinations are i.m. injections, which are biologically
>> quite different from s.c. injections and also from venipuncture. The
>> official recommendation by the Australian Immunisation Handbook is not to
>> swab (so if you follow that, you are following official recommendations),
>> and only to swab if the injection area is visibly dirty, but the problem is
>> that these recommendation are severely misguided and intellectually flawed.
>> ****
>>
>> ****
>>
>> (1) Much of it is based on a short 2001 article in the MJA, examining a
>> few hundred s.c. injections and venipunctures, and concluding that swabbing
>> for ANY type of injection is not necessary, including i.m. injections.
>> There are two fatal flaws with this assumption. (a) The article did not
>> examine even a single i.m. injection and made conclusions pertaining to
>> these (which is inconsistent with the principles of evidence-based
>> medicine, which the article purported to adhere to), and (b) the natural
>> infection rate after i.m. injections is very low, estimated to be in the
>> range of 1:5000 to 1:10000 or less (which is reassuring), but if you study
>> a smaller population than is needed to capture the natural incidence of an
>> event, then you cannot make conclusions that the intervention has no effect
>> on the occurrence of the event. ****
>>
>> ****
>>
>> (2) The recommendation to swab only if visibly soiled is not justified
>> either, because microorganisms are invisible, and implementing this as a
>> cutoff between swabbing and non-swabbing is arbitrary without a scientific
>> base or evidence base. Imagine you sit in front of a patient with a darker
>> skin colour and want to give an injection. When would you be confident that
>> the skin is NOT visibly dirty? ****
>>
>> ****
>>
>> In summary, if you don’t swab, you are consistent with the guidelines,
>> but the guidelines are seriously flawed (at least you won’t be responsible
>> then). It is certainly reassuring that the natural infection rate is very
>> low, and statistically you are unlikely (but it is possible) to see any
>> adverse event. It is clear that i.m. injections and other types of
>> injections are biologically and clinically different and bear a different
>> infection risk. Also, the deeper an injection is, the more complicated
>> infections can get (examples on the complicated end are joint injections,
>> corticosteroid injections, or more complicated injections). ****
>>
>> ****
>>
>> 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****
>>
>> ****
>>
>> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
>> Behalf Of *Franciska Ferreira
>> *Sent:* Monday, 25 March, 2013 8:54 AM
>> *To:* AICALIST@AICALIST.ORG.AU
>> *Subject:* RE; Alcohol swab before injections****
>>
>> ****
>>
>> Hi All,****
>>
>> ****
>>
>> There is still an ongoing debate whether we should use an alcohol swab
>> before administering clexane, vaccines and insulin. Any ideas please?****
>>
>> I know the latest practice in regards administering clexane is to not
>> swab.****
>>
>> ****
>>
>> I just want to advise my team from a infection control point of view with
>> facts to stand on.****
>>
>> ****
>>
>> Kind Regards****
>>
>> ****
>>
>> *Franciska Ferreira*****
>>
>> *INFECTION PREVENTION & CONTROL /WOUND MANAGEMENT CONSULTANT*****
>>
>> Burnside War Memorial Hospital****
>>
>> 120 Kensington Road, Toorak Gardens, SA 5056****
>>
>> *t:** *08 8202 7222 *f:** *08 8407 8573 e:
>> fferreira@burnsidehospital.asn.au****
>>
>> ****
>>
>> ****
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>> kkh****
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