Why spirit is used before injection

First, there is the time investment involved — about 90 seconds per injection- which includes the time to open the packet, clean the skin, and wait for the alcohol to dry. This may not seem like much, but it adds up very quickly. Second, tens of millions of disposable alcohol swabs have to be purchased. Transporting and disposing of these swabs, with a total volume of almost cubic feet, will impact on vaccination clinic logistics and environmental waste.

About one-quarter of adults report some degree of fear of needles so the alcohol swab - and even the associated smell - contributes to anticipatory anxiety. The CNIC had all worked in several wards as staff nurses for more than 10 years. Data were collected from August to November, using individual semi-structured interviews.

Data collection and analysis were performed simultaneously. After interviewing five participants individually, analysis and categorizations were made. After each interview, an analysis confirmed the emergence of new categories.

Up to the eighth participant, a new category was identified each time; hence, more interviews were conducted with additional participants. Two more participants were interviewed, but no new categories emerged.

Therefore, data collection was considered complete with 10 participants. Each interview lasted 30 to 60 minutes. The interviews were held in a private room that allowed two people to converse calmly at a site with convenient participant access. All participants requested to be interviewed at the hospital where they worked, and the first author conducted their interviews accordingly.

Using a semi-structured interview guide, questions were asked in the order shown in Table 1. An interview guide was developed for this study; it was pilot tested with two nurses.

After evaluating their responses, a few questions were revised. At the beginning of the interview, participants were asked about their years of experience as a nurse, their years of experience as a CNIC, and their department. The first author who conducted the interviews transcribed them verbatim, and prepared field notes during and immediately after the interviews.

There were no repeat interviews. An inductive content analysis was used for our data analysis[ 20 ]. The researchers read each verbatim transcript several times to obtain an overall understanding of the content and gain a sense of the whole [ 21 ].

The codes were sorted into subcategories based on similarities and differences [ 22 ]. Depending on the relationships among subthemes, a larger number of subthemes can be organized, or combined, into a smaller number of themes [ 22 ]. After assessments across subcategories, overarching themes were derived.

When discrepancies in coding occurred, the researchers of this study discussed and resolved them through consensus. The process was repeated until the content of each interview was compared with the content of all other interviews. Through the process, emerging findings could be identified and comparative commonalities could be extracted. This series of analyses methods were performed by three researchers. Two of them are nurses with experience of working in hospitals; the other is an occupational therapist with experience in medical practice.

All three are experienced in qualitative research. The credibility of the research findings was established using member checking and peer debriefing. Transferability was ensured via detailed descriptions of the research process. Dependability was achieved by checking the consistency of the findings. The first author, who conducted the interviews, did not have a prior relationship with the participants, which helped participants to freely provide their opinions and perceptions, which were accurately transcribed to promote authenticity.

This study followed the guidelines set out by the Helsinki Declaration version. The study was approved by the Hokkaido University Graduate School of Health Sciences Ethics Committee and the ethics committee of the study site 13— They were informed that personal information would be managed appropriately, and that colloquial and written data would be discarded at the end of the study. The above aspects were explained verbally and in writing, and written consent was obtained.

After this, the researchers began to schedule interviews. The researchers conducted semi-structured interviews with 10 CNIC, followed by an inductive content analysis. The decision to disinfect or not was influenced by perceptions and responses of the people who received care. One reason for skin disinfection before administering subcutaneous injections was that it is common practice.

Participants worried that omitting this step would not be acceptable, and would instead induce anxiety in the patient. They also reported that they would agree to omit skin disinfection if it became a common practice with injection patients among the general public. Some merits of omitting skin disinfection before subcutaneous injection as part of standard care were mentioned.

These included the economic benefits of reducing the cost of purchasing cotton for disinfection and disposing of waste, reduction in labor by skipping one of the steps involved in administering injections, and avoidance of unnecessary irritation to the skin caused by disinfectant solutions.

As described above, the participants recognized the specific benefits of omitting skin disinfection before subcutaneous injection. Hospitals have standards that staff must follow to provide patients with a certain quality of care. Participants said that, because they worked in a hospital, they followed hospital norms.

Even if they personally believed that skin disinfection was unnecessary, the hospital rule was to disinfect the skin before administering every injection. Hence, they had no option to skip the step of skin disinfection.

Thus, one of the reasons nurses used skin disinfection before subcutaneous injection was adherence to hospital norms. Participants were concerned about the risk of infection when skin disinfection was omitted before subcutaneous injection. They reported that the purpose of alcohol disinfection before administering subcutaneous injections was to remove bacteria from the skin and prevent infection. Disinfection may not completely prevent infection, but it is practiced on the assumption that the risk of infection can be reduced.

Participants recognized that omission of skin disinfection before subcutaneous injection was unlikely to cause infection based on literature demonstrating that skin disinfection prior to subcutaneous injection was unnecessary and knowledge of subcutaneous anatomical physiology.

However, they were still concerned about infection, and it was difficult for them to actually introduce the practice of omitting disinfection before subcutaneous injections. If omitting disinfection of the skin before subcutaneous injection became the standard, it was feared that disinfection might be omitted even in situations where disinfection was necessary.

To avoid persistent suspicion of infection, the nurses continued the practice of skin disinfection before subcutaneous injection. One reason considered by the participants for continuing disinfection was that it posed no significant harm to the patient.

Although problems owing to exposure to alcohol could occur, they were not considered a significant disadvantage compared with many other infection control issues in hospitals. Participants perceived that it was not necessary to actively consider omitting the practice of disinfection prior to subcutaneous injections, as it is not detrimental for patients if continued.

The nurses were taught that disinfection before subcutaneous injection was necessary from the time they were students, and there was no opportunity to reflect upon the necessity of the practice even after they had started work.

Nurses routinely administer injections after skin disinfection without questioning its scientific basis. Thus, it has become a deeply ingrained practice.

Other studies concur with these findings and suggest that generally there was insufficient contaminating of skin to cause infection following injection without disinfection and that skin cleansing was an unnecessary procedure. Further research has reinforced the importance of ensuring that the skin of the patient is physically clean and that healthcare providers maintain high standards of hand hygiene prior to the procedure.

Another study carried out a review of best practice in relation to the prevention of injection associated infection for the World Health Organisation WHO.

In association with their Safe Injection Global Network, the WHO no longer recommend swabbing clean skin with a disinfectant before giving intradermal, subcutaneous, and intramuscular needle injections. The American Centre for Disease Control and Prevention issued the following guidance specifically for smallpox vaccine administration.

It states that alcohol, soap and water or chemical agents are not needed for preparation of the skin prior to vaccination, unless the skin is grossly contaminated in which case, cleansing with soap and water are the preferred agents. Skin must be thoroughly dry in order to prevent inactivation of the vaccine being administered. If soiled, skin should be cleaned, based on basic common standards with soap and water. However other reseachers 8,9 have recommended the cleaning of the injection site in order to minimise the risk of infection, the most common solutions for preparing the skin prior to injections are ethyl alcohol and iodophors.

Some studies have cautioned not to use the alcohol swab post injection as the cleaning material can be tracked along the needle path causing irritation.

Other research 10 suggests that antiseptics in current use cannot act in the time that is generally used in practice; approximately five seconds on average and cannot possibly provide complete sterility.

Allowing the site to dry prevents stinging if alcohol is taken into the tissues upon needle entry. It should be borne in mind that although many authors, consider skin disinfection to be unnecessary their research methodologies have been questioned. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies. Hide glossary Glossary Study record managers: refer to the Data Element Definitions if submitting registration or results information.

Search for terms. Save this study. Warning You have reached the maximum number of saved studies Effectiveness of Alcohol Swabs for Preventing Infections During Vaccination The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U. Federal Government. Read our disclaimer for details. Recruitment status was: Recruiting First Posted : April 27, Last Update Posted : May 2, Study Description.

At present, however, clinical trials do not demonstrate a clinical impact of using or not using alcohol swabs on infections and infection symptoms calling into question the practice of using it prior to all injections. These studies are methodologically flawed, and do not specifically examine vaccine injections.