To swab or not to swab prior to Insulin Injections - page 3
by AussieKylie 18,931 Views | 27 Comments
:wavey: Hi Enquiring to find out since the internet is not helping me out much. There seems to be a debate about whether to alcohol swab the injection site prior to giving Insulin injection? I have asked my teachers at Uni... Read More
- 0Jan 25, '05 by FluesySome very good rationales given here. We are swabbing in hospital but not if the patient is self - administering. The rationale being that inside a hospital there is greater risk of abnormal bacteria and infection but now I have read your replies I might just think about our policy some more.......................
- 0Apr 12, '05 by studiousHi there,
I thought I was the only one who didn't swab, so did not reply to a thread I read from the USA that said to swab. Anyway, in case anyone is interested there is another good site PRODIGY guidelines. They also go on about to clean or not to clean a healing wound, there must be guidance in there as well regarding swabbing before injecting or cannulating a patient.
- 0May 6, '05 by GraynurseHey all, I thought I would just add the Queensland point of view...... We are told not to swab the site for an insulin injection, but we have to swab for cannulation and veni-puncture.... someone earlier said that 'alcohol interferes with insulin' (I hope I quoted that right) I would be very interested in this, as we swab the insulin vials before we draw up the insulin
- 0May 9, '05 by fly-galMy hospital policy in San Francisco is to wipe area clean with alcohol swab, then dry with sterile gauze for insulin injections and blood sugar checks. This is because of nosocomial infections (a co-worker of mine just discovered she has MSRA on her skin after her poison oak lesions got infected... she most likely got the MSRA from work). When the patients go home, we instruct them to wash well with soap and water.
With venipucture, we'd most definitely wipe very well with alcohol swabs. The rubbing action is apparently what actually gets rid of most of the nasty bugs, not the actual alcohol. Anyway, that IV line is going to be sitting in someone's vein for at least 3 days (we must change ours every 3 days), so you can imagine if someone's skin appeared to be clean, but really wasn't (I've wiped grime of dark-skinned patients who appeared clean).
We had a true in-house story about a patient who fell and got a scratch on their elbow (luckily the RN reported it to the MD and wrote this down). Turns out, the MD did nothing about it and ended up getting sued after the patient died from sepsis... Extremely unlikely to happen, but can. Now, that is probably the other reason we swab - to add another piece of clarity in case anyone sues! Of course, the other reason we do so is from evidence based practice... which obviously has produced different results from our UK counterparts.
In general, I think we are pretty anal about preventing nosocomial infections in the US. We wash incessantly or use alcohol based cleaning solution - everytime we go in and out of a room, everytime we touch a patient, everytime... all due to evidence based practice. Actually, recently it's been found that the alcohol based cleaning solution is much more effective than just soap and water but one must rub very well as it is the rubbing that actually gets rid of most of the germs... I'm interested to find out what the policy is in the UK as I had a patient from the UK not long ago who said he was amazed how often we cleaned our hands compared to UK nurses. Of course, I have no way of knowing if that is the reality (that perhaps our studies have returned different results), or if the nurses were not following policy.
- 0May 13, '05 by PamUKThis text is taken from the procedure at my hospital (I wrote it!). Note the 30 seconds, not 30 minutes.
Skin Preparation (IM & SC)
Cleaning the skin with an alcohol swab reduces bacteria but studies by Dann (1969) and Koivisto & Felig (1978) suggest that omitting this practice does not result in higher rates of infection. Additionally, swabbing before an SC injection pre-disposes the skin to be hardened by the alcohol.
The Trust now accept that, if the patient is physically clean and the nurse maintains a high standard of hand hygiene, skin preparation is unnecessary. For effective skin preparation, clean the area with an alcohol swab for 30 seconds and allow to dry for a further 30 seconds (Simmonds 1983). Injections given before the skin dries not only increases pain on needle entry as the alcohol penetrates the skin surface, but bacteria are not rendered inactive and may be inoculated into the injection site (Springhouse Corporation 1993).
- Dann, TC 1969 Routine skin preparation before injection. An unnecessary procedure. Lancet ii, 96-98
- Koivisto VA, Felig P (1978). Is skin preparation necessary before insulin injection? Lancet I, 1072-1073
- Simmonds BP (1983) CDC guidelines for the prevention and control of nosocomial infections: guidelines for prevention of intravascular devices. American Journal of Infection Control 11, 5, 183-189
- Springhouse Corporation (1993) Medication Administration and IV Therapy Manual. Second edition. Pennsylvania, Springhouse Corporation
Hope it helps.
- 0Jun 19, '05 by einahpetsSwabbng removes microbes from the injection site, but the wetness of the alcohol can cause airborne microbes to attach to the skin, so do not blow or fan to dry the alcohol site. Apply in a cirular motion and allow to dry. good question with much controversy. take care. wear gloves. wash well and frequently.
- 0Jun 19, '05 by BowlerRNI was always taught that diabetics did not use alcohol swabs in their homes, because they were around there normal flora and in the hospital there is increased risk of nosocomial infection, but I have never heard of these studies that say not to use alcohol i find it very interesting.
- 0Jul 2, '05 by JACLPN-RNQuote from Karen30I just recently went through an inservice at my hospital and the policy states that "swabing" is optional. However, this is the first time that I have been exposed to the concept of not cleansing the site with alcohol. I guess one just has to follow the protocol where you work.I reply to this thread in two capacities, both as a nurse and someone whose family member has diabetes. My views and opinions are however the same regardless.
I have been taught never to swab prior to giving a diabetic insulin, for several reasons.
1. Your average diabetic does not swab prior to insulin at home.
2. The alcohol in swabs eventually makes skin tough, dry and hard and thus can make it very painful for a diabetic to inject themsleves with insulin, let alone another person doing it for them.
Providing you, the patient or whoever may be giving the insulin washes their hands then the risks are minimal.