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alcohol wipes/cleaning skin bt/injections
kernow

47 Posts

Posted:  31-Dec-2014 11:59
Hi, Now im sure this has been asked before but we have had a query from a patient as to why we dont clean people skin before injections and taking blood.
I know the hospitals do but we dont in practice and i was wondering if there were any infection control leads on here witgh any advice as to if we need to ???????

blue.tunic.syndrome

1445 Posts



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Posted:  31-Dec-2014 13:08
If the patient is clean you don't need to ! If the patient is filthy clean the site first ;-) 
if you search the forum the evidence links are there, as you guessed it has come up many times. The hospital are using outdated ideas. Some vaccines are also affected by use of alcohol wipes. I think karen has put the links to evidence on before along with needle choice and site info x

Faith x
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Lilywhite

1358 Posts

Posted:  31-Dec-2014 13:24
I haven't looked into taking blood but re vaccines, The Green Book states:

"Cleaning the skin
If the skin is clean, no further cleaning is necessary. Only visibly dirty skin
needs to be washed with soap and water.
It is not necessary to disinfect the skin. Studies have shown that cleaning the
skin with isopropyl alcohol reduces the bacterial count, but there is evidence
that disinfecting makes no difference to the incidence of bacterial complications
of injections (Del Mar et al., 2001; Sutton et al., 1999)."


UK Guidance on Best Practice in Vaccine Administration 2001 states:

"Administration of vaccine
Skin cleansing is not necessary in socially clean patients. Soap and water are adequate
where a nurse feels skin cleansing is required. If spirit swabs are used the skin should
be allowed to dry before the vaccine is administered (this is essential for live vaccines
which may be inactivated by alcohol).1"

Please be aware this is my opinion only based on the evidence I have seen, and not meant to be taken as direction
angel66

1006 Posts

Posted:  31-Dec-2014 13:51
I always clean skin with alcohol swab for taking blood.Why take the risk of introducing bacteria on skin direct into blood stream?For vaccines,I do for visibly dirty skin.Dry well for both with cotton wool swab.I did hear of a case where a pt tried to sue someone who got an infection post injection and blamed the nurse for not swabbing!
alicog

418 Posts

Posted:  31-Dec-2014 20:46
we too have recently brought in the cleaning of skin with alchohol swab and air drying or wiping with cotton wool prior to taking blood but not before vaccines . Gps decided that entering a vein is very different to doing an IM injection and that swabbing should be part of the procedure.
anon-i-mouse

304 Posts

Posted:  05-Jan-2015 08:56
as per Lilywhite, I haven't cleansed skin for a long time ... I was told that wiping vigourously upset skin flora and made it more likely to cause problems ... but i'll be interested to see if we are going back to alco wipes routinely! ... as a regular blood donor, I know that it stings like mad if the darn stuff isn't allowed to dry properly!!![:o]
kernow

47 Posts

Posted:  07-Jan-2015 12:20
Thanks so much girls, with all the CQC coming to visit want to make sure we are doing everything correct.

abigail89

166 Posts

Posted:  09-Jan-2015 21:24
We were taught to alcohol swab before venepuncture BUT told to swab in concentric circles from the site outward and for half a minute to be effective - then the skin must be left to dry. Where I now work we don't swab unless obviously unclean skin.
karen.rudd

11760 Posts

Posted:  09-Jan-2015 21:37
I have spent a lot of time searching for guidance on this. After looking at SOPS for six different areas of the UK there seems to be very little concensus and even less rational evidence??

The majority do not mention skin cleansing

Those that do either point out that it is controversial and very little evidence for doing it? Some cite work done to say that it causes pain and can disturb skin commensals with implications of causing infection and that cotton wool fibres left behind can cause problems if drying with it which is why dental rolls were often used with tape over at the end of the procedure?

Those that stipulate skin should be swabbed (without referencing reasons why) do stress that the alcohol swab should be allowed to air dry. Non of them stipulate how long it should be left to dry?

So I suppose it is not clear cut but probably a good idea to check what your local phlebotomy guidelines are in a community setting in your area?

Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.

karen
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captiva

51 Posts

Posted:  11-Jan-2015 09:06 Log in to like this post
I was thought that cleaning the skin with alcohol only on visually dirty skin. If using alcohol wipes u supposed to wait until full dry before vena puncture as the alcohol can obscure some blood results. if leaving the skin to dry throughly then palpating for s vein again u are just contaminating the skin again so what's the point.
angel66

1006 Posts

Posted:  11-Jan-2015 14:24
Not heard of interfering with blood results. What does it do? Suppose to wear gloves Captiva although know many do not ( me included) but I do always wash my hands well and use alcohol gel on them before taking bloods, so I could be doing same with the alcohol gel on my hands?
mrscat

372 Posts

Posted:  11-Jan-2015 22:27
I really think it is to do with hospital acquired infections and if patients wounds get infected with mrsa etc the hospital get fined, the hospitals are only allowed so many cases of mrsa in one year. So the fact that they do it in hospitals the rationale is that it should be done in the community.

astrid

92 Posts

Posted:  12-Jan-2015 06:42
I don' t cleanse the skin unless it dirty for either procedure unless skin is vis ably dirty.  Those of you that dry the skin after the alcohol wipe is that because of written procedure?  I thought that alcohol wiped skin should always be left to air dry - when I have blood taken at local hospital they use a alcohol spray and the procedure always stings :( 
suem1

27 Posts

Posted:  02-Dec-2015 16:49
At our recent phlebotomy update we were told you should use wipe before taking blood, but I dont for injections

suem1
mumnurselover

1407 Posts

Posted:  02-Dec-2015 21:30
Friend who is at uni on student nurse course last week did injections and told never for injections or blood taking unless the skin is dirty.

mrscat

372 Posts

Posted:  04-Dec-2015 08:51 Log in to like this post
I don't think there is a national consensus on this, I think it is basically down to local infection control policies.
As hospitals have to be more rigorous in there infection control than primary care in regard to venepuncture etc. (as if a patient ends up getting an infection it will hit the hospital in the pocket) they ensure that everything is being done to prevent an infection no matter what any guidance states.
I found it strange going for hospital to practice nursing and not having to swab beforehand. I will have hospital nurses and doctors question me if I don't swab beforehand, as it is drilled into them to clean they think it is bad practice if you don't. As lots of patients are going to phlebotomy clinics now the local NHS trust may also have the same policy of swabbing as well. Hence patients get confused and will question.
Gloves are worn for your protection to help prevent transmission of blood borne virus's. They are shown to wipe any blood from the needle prior to it going into your skin. Hence another defence. They are not there for infection control.

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