Do there exist any standards or publications, which define clearly for which injections (i.v, i.m ...) and punctures you have to use sterile swabs?

Viola Buchrieser

Dear Viola

I would like to refer to "Prevention and Control of Nosocomial Infections" of Richard P. Wenzel (third edition) in which he states that "the use of an antimicrobial solution at the site of injection usually represents no more than a ritual or, at best, superficial skin cleansing, although proper disinfection seems to be necessary at least before deep intramuscular injections especially of agents evoking local ischemia or causing tissue damage."

Walter Accoe
Gent, Belgium

Dear,

The WIP (Dutch workingparty on Infection Prevention, www.wip.nl) advices to only disinfect the skin in case of i.v. or i.m. injections when it concerns

• a seriously immune compromised patient or
• when a foreign body e.g. an infusion cannula is left behind.

Thea Daha
Working party on infection prevention
LUMC - C9-43
Postbus 9600
2300 RC Leiden
The Netherlands

Dear

The need for sterilized swabs for skin disinfection before injections seems still to be controversial. However research and observation on the effect and the need of sterilized swabs used for injections were made several years ago by Kaiser/Fischer (1987). In these studies several spore forming Clostridien species were isolated on not sterilized cellulose swabs. Already earlier 1982 Lenk reported the dead of a patient due to anthrax spore cause by using unsterile swabs (alcohol cant inactivate spore).
As the actual number of infection due to unsterile swabs is not known it is important to exclude this possible transmission path. The state of the art is "Swabs rather without spores" ergo use only sterilized swabs for skin disinfection.

Josy Holdener