Question: should an alcohol swab be used before giving an intramuscular or subcutaneous injection?
Answer: there is no need to use an alcohol swab before administering an injection unless there is a valid clinical reason for doing so.
Literature review
In a university medical study over 5000 intramuscular injections were administered to patients between the ages of 4 and 66 with no skin preparation and zero cases of infection (localised or systemic) were identified1.
The World Health Organisation supports not swabbing before injecting a vaccine3. The Australian Immunisation Handbook does not recommended swabbing when giving adult or children’s immunisations as alcohol can ‘inactivate’ live vaccines rendering them ineffective2.
Note: a site reaction which can include swelling, redness and warmth is an autoimmune response to an injected virus and is not a needle stick infection.
The argument for not swabbing
Consider how often people with diabetes use lancets on their fingers to check their blood glucose levels and then inject insulin without using alcohol swabs. Add to this thousands of adults and children who receive multiple intramuscular immunisation injections on a daily basis, again without swabs. The practical evidence and literature supports not using an alcohol swab before giving an injection.
The argument for swabbing
Preparing skin with an alcohol wipe before injection is intended to prevent needle stick infection. When this policy was introduced last century, swabbing was based on the presumption it prevented infection and there was no evidence to contradict this belief. A health care setting where organisational policy is ‘to swab’ will also dictate practice.
Swabbing does not cause harm and there are situations where swabbing is a good idea, for example, the injection site is contaminated by blood, dirt, chemicals or poor hygiene.
So which way is ‘right’?
Both methods are ‘right’ and neither method is ‘wrong’. An alternative option is to consider which method is more ‘right’ than the other. In this case, the argument for not swabbing is overwhelming.
Conclusion
It is time to stop arguing and perpetuating the false perception that for every task and situation there can only be one ‘right’ way. The evidence clearly shows there is no need to use an alcohol swab before administering an injection unless there is a valid clinical reason for doing so.
As research and evidence-based practice continues to challenge traditional beliefs, nurses who embrace this concept will accept the challenge and continue to improve their knowledge and skills.
References
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Cocoman, A & Murray, J (2007). Intramuscular injections: to swab or not to swab. WIN. <https://www.inmo.ie/magazinearticle/printarticle/6696>
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Queensland Government (2017). Preparation for vaccine administration (2.2.4). The Australian Immunisation Handbook 10th edn. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part2~handbook10-2-2#2-2-4 >
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World Health Organization (2010). Best Practices for Injections and Related Procedures Toolkit: best practices for injection. Geneva: NCBI. https://www.ncbi.nlm.nih.gov/books/NBK138495/