Experts have stressed the reasons alcohol or methylated spirit must be used to wipe the skin clean before injection is administered.
This timeless medical advice became imperative when a pensioner died of sepsis after a nurse failed to apply an alcohol wipe to her skin before giving her a vitamin injection.
Although the incident happened in the United Kingdom, some hospital users in Nigeria have also said that they sometimes experience the same, hence the need for public education in that regard.
The 77-year-old victim, Patricia Lines, reportedly died less than a week after the nurse gave her an injection to her shoulder without wiping the area of skin first.
She was taken to hospital, where her infection worsened due to bacteria on her skin being pushed deeper into the tissue by the injection. It was heard the nurse did not clean the area because there was no “visibly dirty skin”.
In response, experts are warning nurses to use “common sense” and clean patients’ skin before administering injections, even when the skin is not “visibly dirty.”
Speaking on the “invisible dangers” that lurk on the average skin of a healthy person, Dr. Grace Oritsejolomi says, “Enterobacter, Klebsiella, Escherichia coli, and Proteus spp. are the predominant Gram-negative organisms found on the skin.”
According to her, Acinetobacter spp also occurs on the skin of normal individuals and that, like other Gram-negative bacteria, is more common in the moist intertriginous areas such as the armpits, creases of the neck, between the breasts, between the buttocks, groin, finger and toe webs, as well as the backs of the knees.
Indeed, experts say that Staphylococcus, Corynebacterium and Propionibacterium represent the dominant bacterial genera on skin and illustrate how bacteria adapt to life in this harsh environment and also provide us with unique benefits.
Oritsejolomi advises that because needle breaks the skin during injection, the risk of introducing bacteria into the body is high, hence the need for a wipe before the exercise.
“Alcohol swabs or methylated spirit swab can reduce the number of bacteria on the skin by 47–91%, and that gives reasonable assurance of safety for patience,” the General Practitioner added.
She noted that alcohol wipes and methylated spirit are a “cheap” and risk-free way to prevent similar deaths.
Learning from Patricia Lines’ fate
The inquest earlier this month heard that Ms Lines had a Vitamin B12 injection into her right shoulder on Oct 17 last year. The next day, she became “unwell” and was taken to hospital where she was found to be suffering from a Strep A infection. Despite the best efforts of staff, her condition continued to deteriorate and she sadly died on Oct 23.
A post-mortem found the most likely source was the injection, as bacteria was probably present on the skin at the time and pushed in deeper by the needle. A jury found her death to have been caused by septic shock and delivered a verdict of accidental death.
In a ‘Prevention of Future Death’ review, it was reported that, “The nurse who administered the injection gave evidence that she did not clean the skin prior to administering the injection.
“She did not do so because she was following both her training (she quoted from an NHS e-learning module on administering intramuscular injections) and national guidance in the form of a document titled Immunisation Against Infectious Disease/The Green Book.
“The evidence that I heard at the inquest included that alcohol wipes are relatively cheap and their use does not give rise to any significant risk.
“I note that the Green Book states that cleaning the skin with alcohol reduces the bacterial count.
“Common sense would seem to suggest that reducing the bacterial count would reduce the risk of bacteria being inadvertently introduced into the deeper tissues during an injection.
“Whilst it is noted that the Green Book also makes reference to there being evidence that disinfecting makes no difference to the incidence of bacterial complications, it is also noted that the literature quoted is now over 20 years old.”
“In my opinion, action should be taken to prevent future deaths and I believe your organisation has the power to take such action.”
WHO recommendation
The World Health Organisation (WHO) recommends using an alcohol-based solution to disinfect the skin before an injection to prevent the spread of bloodborne pathogens and other infections.
