Or just a bit precious about injection etiquette?

[SpecialFriedRice]

OK there's no such thing as injection etiquette but couldn't think how to phrase it!

Took DD to have her pre-school booster injections today. They were done by a nurse I think.

When I walked into the room she was tapping away on her computer. She then unpacked the needles and put the bits together etc. Then with no gloves or hand washing and she didn't clean the injection site with those alcohol wipes she injected DD with the first needle and then rubbed the area with her bare hand (to help take out the sting I suppose). I then turned DD round and she done the same on the other side.

So AIBU to expect either gloves and/or freshly washed hands, and for the injection site to be cleaned? I don't know if I'm just being precious. DD's last set of injections (at 13 months) were done at a different surgery and the person definitely washed their hands and used alcohol wipes that time.

I should have spoke up at the time but I thought I was maybe just being silly. But looking back on it, it just seems poor practice.

yanbu!

hand washing in particular is essential.

YANBU. I would expect what you expected.

Gloves are for the protection of the person doing the injection more than the one receiving it, so no real issue there, and the wipes aren't used outside of a hospital setting as there's evidence showing they do more harm than good in a community environment. BUT handwashing is a MUST, I'm astounded she didn't do this!!! I wouldn't dream of even touching a patient without washing or sanitising my hands, even if I knew they were clean I would do it for the patient's peace of mind!

I haven't seen alcohol wipes used for injections or blood tests for a while. not sure why. nor hand washing. ds1 has booster booked tomorrow. will try and remember to ask!

Had two blood tests this am: no alcohol wipes used but the nurses both wore gloves. I would expect gloves and was a bit surprised by the lack of wipes, tbh.

Alcohol swabs pre-injection haven't been recommended for a while as they make the site sting and introduce irritation/reaction and have little effect on infection rates. Area should only be alcohol swabbed if visibly dirty or soiled.

Gloves tend to be an individual practitioner choice as don't really protect the injectee.

If it was an intramuscular injection then the rub afterwards is to help disperse the medication.

But yes, she should have washed her hands.

Using swabs is out of date practice, not using them.

Alcohol wipes no longer used but hand hygiene is a must!

not using them isn't I mean.

Gloves are for the protection of the nurse as much as for your son, and as the injection site is probably tiny, I doubt very much that your son will come to any harm because of the lack of an alcohol wipe. Even the lack of hand washing is unlikely do him harm, so please don't worry.

That said, she should have used all of these precautions as good practice, and I would complain about it tbh.

As an ex-nurse I know what you mean, what I would expect and would demand (and have when OH was ill)

(a) Checked that there was no history of Latex allergy.

(b)Opened needle pack etc. in sterile manner i.e.: peeled open pack so that I was not touching it in any manner and let it fall on to sterile field
(c) Washed hands, put on gloves, assembled injection.

(d) Alco wipe, there is research going on as to how much good if any these do when giving a one off injection.

Now here's where I have a big problem dependant on your answer, when you say she did the same on other side: I'm assuming that she gave another separate injection yes???

Gloves are to protect the healthcare professional not the patient and alcohol swabs are no longer used prior to blood taking and injections as already stated. She may have washed her hands prior to you coming in.
I always did this but now wash them both after the last
patient and in front of the next.

she probably washed them before you came in?? you could ask if you wanted

Didn't know that the wipes were no longer used. So that's good to know now.

I know she could have washed them before we came in but as she was sitting typing etc when I went in, that means she'd been touching her grimy keyboard (Or is it just mine that get yucky with dust and whatnot under the keys?)

Smellslikecatpee - You actually just reminded me. She opened out the packets just onto her desk. And she didnt seem to bothered about what bits she touched etc. I know last time DD had injections everything was on a little cardboard tray thing (made from the same stuff those toilet insert cowboy hat things are).

None of it is the end of the world. It all just seemed a bit... Bish bash bosh job done. Just expected better from someone who does alot of immunisations.

I wouldn't be happy about opening stuff onto desk as there is no need for needle, syringe etc to touch a desk, it can all be done within the packets without being put down on anything. If it needs to be put down it should be on a sterile field, although a cardboard tray or kidney dish are probably not sterile anyway, usually plastic trays in sterile packs in my experience. I'm also interested in whether she gave another separate injection?

I had blood taken a couple of weeks back. The mw didn't use wipes but they did in the blood lab. I promise I'm not skanky!

All sounds perfectly normal for me, i do something similar with my patients but always wash my hands after i have seen the patient and usually a quick squeeze of alcohol before i start and i always use cotton wool to cover/rub the injections site as it often bleeds, bare hands and i may get in myself however her practice puts her at risk not your child.

A) gloves are for me and i don't worry too much about touching babies and i never come into contact with body fluids in my technique.

B) never use alcohol wipe, it's very out dated

C) you can tip the packs where ever you like so long as you never touch the metal part of the needle, those cardboard thingies aren't sterile just for practicle reasons.

The fact that she does so many is probably why its so bish, bash, bosh as you say.

Wipes are still used when taking blood because of the risk of phlebitis.

Theres a risk of cross infection on the computer keys if she didn't clean/ gel her hands after.
I'm in agreement about the wipes though, injecting into wet skin stings as well. ( Can't remember if the nurse who did my flu jab pre-wiped but she didn't wear gloves)

I am always how many of my patients comment when I wash my hands that other medical staff don't.
I always wear gloves (I'm a chiropodist/podiatrist. You just would, wouldn't you) unless I'm checking circulation/sensation and having no skin contact.

Nope, no gloves or cleaning the skin with anything.

I wash my hands between patients so you may not see me doing it before you come in. I have a cotton wool ball handy in case of any arm/leg juice leakage.

There is no requirement for skin cleaning prior to most injections in routine primary care, and as it's a no touch technique then gloves aren't needed. A vaccination is different to a blood test in terms of cross-infection risk.

As long as the sterile needle has been put onto the sterile syringe without touching it, then it's clean. Little trays are not needed and tbh we can't afford to use them. We clean our work surface with alcohol wipes then lay out what we need. The needle cover stays on until the last minute so no risk of contamination.

Magic, wipes aren't used for be ePub tire in my trust as no evidence for reduced infection. Only used for blood cultures.

Bloody I phone, that should say venepuncture!

ePub tire. Brilliant.
OP, I think you are overthinking this slightly. As everyone has pointed out, the needle is the only thing that needs to be sterile. I am assuming it was a preloaded dose.
The worst injection technique my DD had was in Thailand. We all went to a hospital for rabies (I think), me and DH had ours done out of the sight of DD. The nurse came round the curtain, pulled DDs skirt up, moved her nappy out of the way and plunged it in.
I can still remember her screams of outrage.