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  3. Thursday, 08 February 2007
POST 01051E : USE OF ALCOHOL FOR VACCINE INJECTIONS Follow-up on Posts 01029E, 01036E and 01044E 8 February 2007 ________________________________________ This posting contains three contributions. I believe that this will likely settle the issue. The first is from Serge Ganivet (mailto:GanivetS@whoafr.org) from WHO/AFRO in Zimbabwe. The second is from Anil Varshney (mailto:anilvarshney@yahoo.com) from India. Anil had contributed earlier to this discussion. Finally, Adwoa Bentsi-Enchill (mailto:BentsiEnchillA@who.int) and Diana Chang Blanc (mailto:ChangBlancD@who.int) both from WHO contribute an institutional reply. Please note that the most commonly used alcohol as an antiseptic is propanol or Isopropylic alcohol. ________________________________________ Dear all, I am quite surprise that after so many years of EPI we still don't have clear answer to that question. It has been raised so many times and no clear answer has been given so far. In the Vaccination Practical Guideline, it is mentioned only to "clean the skin with water if dirty, it is not necessary to use alcohol" I think that the main question about the cleaning of the skin (if dirty) is between water and alcohol and not between alcohol or nothing. The explanation I got since I work in EPI is that the alcohol does not clean better than water, alcohol could "disinfect / sterilize" the skin only if it is done properly (from top to bottom, etc.) which is not the case most of time and certainly not in 2-3 seconds, and most important alcohol can affect the quality of BCG vaccine that is administered intradermic. As far as I know there is no study showing that cleaning the skin with water is more risky than with alcohol. But using alcohol is more expensive, needs logistics especially for outreach activities, etc. Nevertheless the water should be clean but not necessary boiled. That is my understanding. Regards, Serge ----------------------- Hello All, In this reference please refer to my previous contribution, stating that if skin is clean nothing is necessary and cleaning with plain water is sufficient. In practice I have seen patients using a insulin needle for self-use for more than 6 times before discarding for to be replaced with new one, injecting without use of alcohol or cleaning with water, with no infection reported in last few years. The reason for using the same needle is the cost of needle at Rs. 10/- which is more than the cost of the insulin dose. regards, Anil -------------------------- Viral vaccines with glycoprotein coats ('live' vaccines), such as measles or yellow fever, are inactivated by alcohol. This is also relevant to the smallpox vaccine where the particular vaccination technique (multiple puncture) increases the potential for vaccine inactivation by alcohol at the site of injection (http://www.bt.cdc.gov/agent/smallpox/va ... method.asp). It is questionable whether the minute amount of alcohol that would come into contact with the tip of a needle could negatively affect bacterial vaccines and the subsequent immune response. We are not aware of specific or current literature on this issue. As recommended in the Australian Immunization Guidelines previously circulated by David Hipgrave/UNICEF and the Canadian Immunization Guidelines (http://www.phac-aspc.gc.ca/publicat/cig-gci/index.html), if alcohol or a suitable antiseptic is used, the swabbed skin should be left to dry before the injection is administered. Prior to the injection of vaccines, WHO recommends that skin not be swabbed unless it appears dirty, in which case it is sufficient to clean the surface with water. It is not considered necessary to apply alcohol to clean the skin. (Immunization in Practice, http://www.who.int/vaccines-documents/iip/PDF/Module6.pdf) In the broader context, WHO does not recommend use of alcohol swabs because of programmatic risks that can potentially lead to serious adverse events following immunization (AEFIs). While no published empirical data are known to us, there is a potential for containers of alcohol-soaked swabs to become germ-breeding sites due to alcohol concentrations reducing over time (a particular risk in hot climates) with a resulting risk of cross infection. The infection resulting from such contamination may be localized, or systemic such as in toxic shock syndrome. Additionally, from an operational standpoint, there is the risk that a product other than alcohol or other suitable antiseptic could be used mistakenly by the immunizer, with unintended consequences. Although not directly related to the question at hand, the following article describes an EPI situation where methanol compresses were used post-immunization, leading to fatalities (http://www.technet21.org/pdf_file/Inves ... ne2002.pdf) If swabbing of injection sites with alcohol or other antiseptic prior to immunization is part of national policy, the immunization programme should ensure that adequate control procedures are in place, or preferably use single-use pre-packed swabs. If such measures are not feasible or implementation is unsatisfactory, it is recommended that the procedure of swabbing skin with alcohol prior to immunization be abandoned. Adwoa Bentsi-Enchill, WHO/IVB/Quality Safety and Standards Diana Chang Blanc, WHO/IVB/Expanded Programme on Immunizations ______________________________________________________________________________ All members of the TechNet21 e-Forum are invited to send comments on any posting or to use the forum to raise a new discussion or request technical information in relation to immunization services. 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