The alcohol swab before the needle: A point of debate Or a waste of time?

[jacb]

For many of us, getting a vaccine or other routine injection is not a pleasant experience. But there’s something comforting about the injection site being wiped with an alcohol swab. Other than signaling to us that it’s time to brace ourselves for the needle, it reassures us that good care is being taken to reduce the risk of infection. We know that without it we’d be inviting bacteria into the puncture wound. Or do we?

There is now some evidence that it’s a waste of time … Article LINK

Thoughts?

 

[bixt]

What about the vial? You must wipe the top of your vial before drawing anyway. Who knows what lurks in there.

 

[Vince]

It basically says it could be a waste of time but they really don't know.

 

[tareload]

I would keep swabbing everything (site and bottle vigorously) prior to draw and injection.

BTW, the link to the paper from the article you cite above is broken. Always pays to read the original work and not just an article about it.

So here is the paper:

https://www.cadth.ca/sites/default/files/pdf/htis/2020/RC1218%20Skin%20Prep%20Injection%20Final%20corrected.pdf

Key Findings
One relevant randomized controlled trial was identified regarding the effectiveness of skin
preparation prior to vaccinations in children. The study found that there was no statistically
significant difference in local skin reactions and infection rates when comparing alcohol skin
cleansing to no cleansing prior to vaccinations. The duration of pain was statically
significantly higher in the alcohol swab group compared to the control group. There were no
identified cases of cellulitis, pus leaking and infectious abscess. However, the study was
insufficiently powered to detect a difference in the primary outcome of skin infection. Due to
the limitations of the study it is difficult to draw sound conclusions of whether alcohol
swabbing reduces infection rates compared to no swabbing.
No cost-effectiveness studies or evidence-based guidelines were identified regarding skin
preparation prior to injection.
Methods
Literature Search Methods
A limited literature search was conducted by an informa

 

[Neil]

Most studies about swabbing skin before injection deal with patient populations and clinical outcomes, etc. I don't really care about all of those other people, I care about me. I do use alcohol swabs and was taught to swab the area for several seconds in a circular motion. I believe the chance of a random bacterial infection being transferred from the skin into my bloodstream is minimal, but the costs of alcohol swabs are also small. And since I have been injecting Depo T for over a decade, and hopefully a couple of decades into the future, that's quite a lot of opportunity to provoke random chance. Fact, you can culture some nasty bacteria from the skin. Swab often is what I say.

 

[nightjazz]

(Note Bene, your mileage may vary.) 50 years as a Registered Nurse and Nurse Anesthesiologist, I seldom saw anyone follow the 30 second scrub and 30 second wait for the alcohol to evaporate prior to an injection. Typically swipe and inject in a few seconds. Never saw nor heard of an injected site that did not contain a foreign object (IV catheter generally) left in the injection site having a local infection. Use of alcohol soaked pads to clean injection sites is a sacred cow left from preantibiotic days when needles were large and reused with limited cleaning between uses. I do think that cleaning vial tops with alcohol using the prescribed 30 second rule is a good idea, skin prep not as necessary. As I said above, YMMV. I do not swab skin prior to trimix injection but I do clean vial.

 

[Coopsdaddy]

I keep my vial and needles in a small pelican box and never use swabs.Waste of time if keep in a clean environment.

 

[solothesensei]

I have not used alcohol swabs in years and experienced 0 issues with infection. Even if the vial/skin was unclean, the benzyl alcohol in the solution acts as an antibacterial.

To my understanding the % of benzyl alcohol should range between 1-2% of solution. For antibacterial purposes, it certainly could not hurt to go with 2%.

 

[jacb]

Interesting debate …. I will go on using alcohol swabs but realise that they are probably not needed. I will do this by way of “belt & braces” insurance. However I have, because of this debate, noted the 30 second scrub and 30 second wait rule, if a swab is used.

 

[tareload]

(Note Bene, your mileage may vary.) 50 years as a Registered Nurse and Nurse Anesthesiologist, I seldom saw anyone follow the 30 second scrub and 30 second wait for the alcohol to evaporate prior to an injection. Typically swipe and inject in a few seconds. Never saw nor heard of an injected site that did not contain a foreign object (IV catheter generally) left in the injection site having a local infection. Use of alcohol soaked pads to clean injection sites is a sacred cow left from preantibiotic days when needles were large and reused with limited cleaning between uses. I do think that cleaning vial tops with alcohol using the prescribed 30 second rule is a good idea, skin prep not as necessary. As I said above, YMMV. I do not swab skin prior to trimix injection but I do clean vial.

Question for you given your experience...

You go in for (1) lab work or (2) to give blood and the phlebotomist doesn't prep your skin before sticking you. What would you do?

All you riverboat gamblers feel free to weigh in as well.

 

[Gladiator]

When I had my first covid vaccine I asked why she didn’t swab
Was told the alcohol kills the vaccine, the vaccine goes into the muscle so I don’t get the story.
I feel better to swab and I sometimes swab twice. If I have any trace of brown on swab I do it again

 

[RickD]

I have a cousin who was gardening in jeans and was kneeling in his garden. Next morning one of his knees was swollen right at the point of kneeling contact. He ended up in the hospital with his entire leg swollen like the Michelin man and on IV for 2 weeks, they were concerned he could lose his leg... from kneeling the the garden, with jeans on.

I share this only to illustrate that shit happens.. It takes 2 seconds and costs a few cents to swab, why not do it just in case.

 

[thatcarnarn]

I never swab either.

 

[tareload]

I have a cousin who was gardening in jeans and was kneeling in his garden. Next morning one of his knees was swollen right at the point of kneeling contact. He ended up in the hospital with his entire leg swollen like the Michelin man and on IV for 2 weeks, they were concerned he could lose his leg... from kneeling the the garden, with jeans on.

I share this only to illustrate that shit happens.. It takes 2 seconds and costs a few cents to swab, why not do it just in case.

Some people don't want to bother with insurance?

Have and not need than to need and not have, etc....

 

[tareload]

When I had my first covid vaccine I asked why she didn’t swab
Was told the alcohol kills the vaccine, the vaccine goes into the muscle so I don’t get the story.
I feel better to swab and I sometimes swab twice. If I have any trace of brown on swab I do it again

If anyone can explain the underlying logic and scientific analysis to support this story I would love to hear it. Mind blowing.

I like the gif better than video but here's the source (as per usual):

 

[MDavidW76]

When I inject I swab everything, paranoid - maybe, but it’s what I was taught to do as I grew up around doctors and such. Scrub hands, turn off faucet with elbow if possible etc.

 

[GreenMachineX]

When I inject I swab everything, paranoid - maybe, but it’s what I was taught to do as I grew up around doctors and such. Scrub hands, turn off faucet with elbow if possible etc.

I swab everything too, and sometimes swab it all twice, but I freely admit I'm paranoid LOL

 

[JmarkH]

I'm a swabber. Mostly on myself.

 

[nightjazz]

Question for you given your experience...

You go in for (1) lab work or (2) to give blood and the phlebotomist doesn't prep your skin before sticking you. What would you do?

All you riverboat gamblers feel free to weigh in as well.

Lab work, I don't care about it. Blood donation is a whole differst matter to protect the recipient requires a betadine or equivalent skin prep and scrub.

 

[GreenMachineX]

When swabbing the vial or your skin, do you always let it dry completely before puncture? Does it matter?