January 21, 2002 What is the proper skin preparation for an injection?
 Assuming the skin at the injection site appears clean, what is the recommended approach to skin preparation prior to an injection such as the contraceptive DMPA?
- Wipe with a single use antiseptic swab and inject immediately.
- Wipe with a single use antiseptic swab.Wait for a recommended "contact time" for the antiseptic to take effect, and then inject.
- Wipe with cotton previously soaked in antiseptic and inject immediately.
- Any of the above.
- Don't bother to swab the skin at all. Just give the injection.
 The best answer is e) - Just give the injection
According to WHO and its Safe Injection Global Network (SIGN), "Swabbing of the clean skin prior to giving an injection is unnecessary." "In controlled studies comparing the risk of infections ...., no infections were reported among patients who did not receive any skin preparation protocol. And "Review of microbiological studies do not suggest either that wiping the skin with an antiseptic before intradermal, subcutaneous and intramuscular injections reduces the risk of infection.
Partial credit for answer b)? Possibly. Clearly many providers do swab the skin prior to injection and one could argue that there is no harm in it. SIGN does make the point that if swabbing is done, it should be done with a single use swab and then wait for the recommended contact time before injecting. But in fact, wasting time, money and other resources on an unneccessary procedure detracts from the ability to provided needed services. And in actual practice few providers will wait the few minutes of contact time before injecting.
In any case c) is clearly not recommended. According to SIGN. "... unsafe skin preparation protocols may be harmful." "Cotton balls stored wet in multi-use container must not be used." Yet, this may actually be the most common practice in many developing countries.
References:
Hutin Y et al. Best injection practices for intra-dermal, subcutaneous and intramuscular needle injections. WHO, Safe Injection Global Network, Geneva, 2002.
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The "Pearls" offer answers to commonly asked questions about family planning. These "Pearls" are prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID)
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