POST 00539E : ASPIRATION BEFORE INJECTION Follow-up on Post 00537E 12 January 2003 ___________________________________________________________________ Mary Catlin (mailto:[log in to unmask]) from the USA makes some comments on John Clements' reply to Bernard Kaic. This is followed by a short comment by Silvia Bino (mailto:[log in to unmask]) from Albania. Finally, some further comments from Veronica Isaacs (mailto:[log in to unmask]) from South Africa. ___________________________________________________________________ Just a comment on this part of the answer- "If the intended vaccination site is visibly dirty, obvious dirt can be removed using clean water, water for injection or saline and a clean tissue, cloth, cotton wool, gauze or other such non-impregnated material. Wipes that are impregnated with medicated chemical must not be used." I would disagree that single-use alcohol wipes are harmful - most of the clinical trials in the U.S. evaluating the efficacy of vaccines are done wiping the injection site without evidence of inactivity. A more moderate position would be to warn people that shared vials of many skin antiseptics and pre-wettened cotton can become contaminated, and that routine skin cleansing, in WHO's opinion, can be omitted. But you will conflict with the ACIP guidelines you quoted (the current version at least !) if you actively ban use of alcohol cleaning at the site. While the SIGN committee recently decided that there was no evidence showing that skin antisepsis prior to injections was cost effective, we must be careful not to generalize this to other settings and other procedures. There is good evidence about the role of skin antiseptics used before IV placement, obtaining blood cultures, central lines placement and some suggestive evidence about the benefit of antisepsis for IV drug users. RE aspiration: now that tens of millions of injections have been given with vaccines into standard sites with AD syringes, we at least do have substantial field experience that injection with EPI vaccines into standard sites has not had reports of adverse events. Happy New Year to Technetees. Mary Catlin Injury and Infection Prevention Tucson, AZ USA _________________________________________________________ I fully agree with Dr.Clements response. Aspiration prior to injection is not a good practice and itself can cause harm by losing control and also all AD syringes we use do not permit aspirations. Dr.Silvia Bino Albanian Institute of Public Health _________________________________________________________ I think the query of Bernard Kaic is relevant. I am a nurse by profession trained in the late sixties. Aspiration before injection is just regarded by many well-trained nurses as part and parcel of safe injection practice. This became a positive habit even with the administration of vaccines even though the correct site for vaccination poses a lesser risk of getting into blood vessels. This of course is not possible with the AD syringe which does not allow for aspiration. This I suppose will become acceptable practice since the use of the AD syringe is approved , also for reasons of injection safety. Once again, I suppose not so much for the recipient but moreover for the administrator. We, in South Africa are not using the AD syringe and therefore do not know whether any AEFI as a result of this has been reported/investigated, definitively not in our province. Veronica Isaacs , EPI Manager, Department of Health , Provincial Administration Western Cape , Cape Town, South Africa. ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[log in to unmask] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopÃ©ration internationale en santÃ© et dÃ©veloppement, QuÃ©bec, Canada (http://www.ccisd.org) ______________________________________________________________________________
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