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

[tareload]

Short answer...you are good. Swab the area vigorously with 70% IPA/Ethanol, draw up your injection, and inject. Swab the vial top and then your injection site. Good practice and you aren't injecting or drawing from an artery; you are injecting into a fat pad or muscle. Good job and great question.

Dirty details which no one wants to read (hat tip to the Germans):

https://journals.asm.org/doi/full/10.1128/AAC.00582-09

 

[GreenMachineX]

Short answer...you are good. Swab the area vigorously with 70% IPA/Ethanol, draw up your injection, and inject. Swab the vial top and then your injection site. Good practice and you aren't injecting or drawing from an artery; you are injecting into a fat pad or muscle. Good job and great question.

Dirty details which no one wants to read (hat tip to the Germans):

https://journals.asm.org/doi/full/10.1128/AAC.00582-09

View attachment 27540

Thanks. I probably need to swab a little more vigorously though. Thanks for entertaining my paranoia

 

[tareload]

Venepuncture for blood donaton - WHO Guidelines on Drawing Blood - NCBI Bookshelf

Compare with blood draw for donation.

 

[Gladiator]

Need some help here...unsure if my paranoia is back in full swing or if this is a legit concern.

Does the alcohol swipe kill everything on the skin, like fungus, mold, etc? In other words, if I have a mold/mildew issue in my home (still figuring this out), the bathroom is the area where I do my shots, shower towels don't dry completely from each shower, could this potentially cause an issue or would the alcohol pad kill it, or would the amount of potential spores in the air then growing on the towel used a few times be a ridiculous thought, or does the alcohol pad swipe (or natural defense on the skin) prevent infection from injection?

When I had my first Covid vaccination the nurse didn’t swab. I asked her why she wasn’t swabbing first and she told me because the alcohol kills the vaccine. Lucky I showed before I went.

 

[MDavidW76]

When I had my first Covid vaccination the nurse didn’t swab. I asked her why she wasn’t swabbing first and she told me because the alcohol kills the vaccine. Lucky I showed before I went.

It’s a lypophilic vaccine so it could ruin the vaccine if you mixed alcohol in it, but that’s not how they do it… they used alcohol pads when they did our vax at our work clinic

 

[Vince]

When I had my first Covid vaccination the nurse didn’t swab. I asked her why she wasn’t swabbing first and she told me because the alcohol kills the vaccine. Lucky I showed before I went.

I think she got it mixed up with consuming alcohol before the vaccine.

 

[tareload]

I think she got it mixed up with consuming alcohol before the vaccine.

Or perhaps she consumed too much alcohol before administering the vax?

 

[tareload]

It’s a lypophilic vaccine so it could ruin the vaccine if you mixed alcohol in it, but that’s not how they do it… they used alcohol pads when they did our vax at our work clinic

To be clear, vax is in the syringe and alcohol rubbed on skin before needle goes in arm. There is 0% probability than any slight residual alcohol on the surface of the skin will find the vax as the vax goes under the skin after needle injected. Keep wiping those injection sites fellas.

 

[GreenMachineX]

When I had my first Covid vaccination the nurse didn’t swab. I asked her why she wasn’t swabbing first and she told me because the alcohol kills the vaccine. Lucky I showed before I went.

That's weird. I wonder how many people she gave the vaccine to without swabbing...

 

[Gladiator]

That's weird. I wonder how many people she gave the vaccine to without swabbing...

Hundreds probably. It was a clinic with a line that was an hour long. 16 different injection cubicles so I don’t know how many didn’t swab. I’m guessing all of them. You had to book a month in advance to get a place then still line up for an hour.

 

[Matthew1975]

When I had my first Covid vaccination the nurse didn’t swab. I asked her why she wasn’t swabbing first and she told me because the alcohol kills the vaccine. Lucky I showed before I went.

I have a feeling they ran out of alcohol pads; her statement is dripping with ignorance.

 

[Matthew1975]

The primary reason to swab the skin with alcohol is to clean the injection site, and provide some antiseptic mechanism. The 30 second dry time is to allow the evaporation of the alcohol to kill as many bacteria on the skin as possible.

I've noticed comments about not swabbing, and it makes zero sense to not swab. I've seen comments about swabbing or not swabbing for lab work or an IV. Again, foolish.

Even with swabbing, there is a very small risk of getting an abscess with a sub-Q or shallow IM injection, but there is no valid reason to not swab with alcohol or chlorhexadine prior to lab work or initiating intravenous access of any kind. This is a direct pathway into the bloodstream, bypassing the defenses we have in our layers of skin.

As a medical professional of 17+ years, both Critical Care and ER, I question the professional veracity of anyone who claims to be a medical clinician and states it's fine to not swab for lab work or similar venous access.

Evidence? Blood cultures drawn on what seem to be properly prepped skin, e.g. cleansed with chlorhexadine or povidine/iodine, sometimes come back "contaminated" with skin flora, which is why when blood cultures are drawn, 2 sets are taken, as it is highly unlikely that both sets of cultures would be contaminated with skin flora. If that bacteria can travel into the culture bottle, it can also be introduced into the blood stream.

 

[GreenMachineX]

The primary reason to swab the skin with alcohol is to clean the injection site, and provide some antiseptic mechanism. The 30 second dry time is to allow the evaporation of the alcohol to kill as many bacteria on the skin as possible.

I've noticed comments about not swabbing, and it makes zero sense to not swab. I've seen comments about swabbing or not swabbing for lab work or an IV. Again, foolish.

Even with swabbing, there is a very small risk of getting an abscess with a sub-Q or shallow IM injection, but there is no valid reason to not swab with alcohol or chlorhexadine prior to lab work or initiating intravenous access of any kind. This is a direct pathway into the bloodstream, bypassing the defenses we have in our layers of skin.

As a medical professional of 17+ years, both Critical Care and ER, I question the professional veracity of anyone who claims to be a medical clinician and states it's fine to not swab for lab work or similar venous access.

Evidence? Blood cultures drawn on what seem to be properly prepped skin, e.g. cleansed with chlorhexadine or povidine/iodine, sometimes come back "contaminated" with skin flora, which is why when blood cultures are drawn, 2 sets are taken, as it is highly unlikely that both sets of cultures would be contaminated with skin flora. If that bacteria can travel into the culture bottle, it can also be introduced into the blood stream.

Unrelated question, but in true emergency situations, do medical professionals swab skin before injecting epipen, for example? TV and movies always show needles being jabbed through clothing and such. Wasn't sure how accurate or inaccurate the was, or if it depended on the issue (tension pneumothorax for example).

 

[tareload]

Unrelated question, but in true emergency situations, do medical professionals swab skin before injecting epipen, for example? TV and movies always show needles being jabbed through clothing and such. Wasn't sure how accurate or inaccurate the was, or if it depended on the issue (tension pneumothorax for example).

No they don't because risk of death a little more important (airway closing / time sensitivity) than potential infection. It is always a risk/reward calculation.

For casual injection where you have all the time in the world it is foolish to not properly prep injection site. But hey, lots of people love gambling. Have fun.

 

[tareload]

Blood cultures drawn on what seem to be properly prepped skin, e.g. cleansed with chlorhexadine or povidine/iodine, sometimes come back "contaminated" with skin flora, which is why when blood cultures are drawn

Excellent. For the reader see paper above. Those skin sites even after prep are not sterile. Just a 2 log kill. The bare minimum to "clean" up the site. Keep swabbing.

 

[Vince]

No they don't because risk of death a little more important (airway closing) than potential infection. It is always a risk/reward calculation.

For casual injection where you have all the time in the world it is foolish to not properly prep injection site. But hey, lots of people love gambling. Have fun.

Yep, I agree 100%. I've been trained on using the EpiPen, you jab the person right through the pants leg.