Swabaholics?

Lack of effect on blood alcohol level of swabbing venepuncture sites with 70% isopropyl alcohol

OBJECTIVE

It is standard practice to clean the skin using a non-alcohol-containing swab before forensic blood alcohol sampling, because of the belief that the use of an alcohol-containing swab will contaminate the sample. The present study aimed to determine whether cleaning the skin with 70% isopropyl alcohol swabs, before venepuncture, alters measured blood alcohol level (BAL).

METHODS

Volunteers aged >18 years had paired venous blood tests, which were drawn within 2 min of each other. One arm was swabbed with a 70% isopropyl alcohol swab and allowed to dry before venepuncture. The other was swabbed with saline, and these concurrent samples were used as controls. BAL was tested using the enzymatic method. Pathologists analysing the samples were blinded to the swabbing technique used. The mean differences and standard deviations of each of the paired samples were analysed using Student's t-test.

RESULTS

Fifty-six paired venous blood samples were obtained from volunteers. Mean BAL in the isopropyl alcohol-swabbed group was 3.27 mg/dL with a standard deviation of 1.14 mg/dL. Mean BAL in the saline-swabbed group was 3.41 mg/dL with a standard deviation of 1.11 mg/dL. The mean difference was 0.14 mg/dL, with a standard error of 0.157. There was no statistically significant difference between the groups.

CONCLUSIONS

The present study demonstrated that the use of 70% isopropyl alcohol swabs does not significantly affect BAL when used before venepuncture. This has implications that challenge current forensic blood alcohol sample acquisition.

Skin disinfection and acupuncture

The need for skin disinfection before insertion of an acupuncture needle is controversial and there is no specific research on this topic. However research and observations on the effect of, and the need for, skin disinfection before injections forms a good analogy of acupuncture. Whilst micro-organisms present on the surface of the skin are accessible to disinfection, those located under the surface in ducts, glands and follicles are out of reach and can be inoculated into the sterile tissues below by needle insertion. Fortunately, the bacteria resident on the skin have a low potential to cause infection if host immunity is not severely impaired or compromised by the long-term presence of foreign material, such as a surgical stitch. Disinfection of clean skin before injection is not generally considered necessary and observations of lack of infection following injections without prior skin disinfection support this; however, contamination by micro-organisms not normally resident on skin can pose a higher risk of infection. If skin is visibly soiled, it should be washed and if needle insertion is near an infected or contaminated site, it should be disinfected with alcohol. Practitioner hand hygiene between patients is important, even if gloves are worn. Hands should be washed with soap or detergent and water, or an alcohol handrub can be used if hands are physically clean.

Are sterile conditions essential for all forms of cutaneous surgery? The case of ritual neonatal circumcision

BACKGROUND

Many aspects of cutaneous surgical interventions have been perfected, employed, and then scientifically examined. Conversely, ubiquitous, indiscriminate demand for sterile conditions while performing an invasive procedure remains a field devoid of satisfactory critical appraisal.

OBJECTIVE

Ritual neonatal circumcision served as a prototype to assess scientifically the safety of performing a dermatologic intervention under clean, uncontaminated, but nonsterile conditions.

METHODS

Two hundred subjects, mostly neonates, who were unselectively referred for ritual circumcision, served as the study group. The guillotine excisional technique was employed in the community setting under clean, uncontaminated, nonsterile conditions, in line with traditional practice. Follow-up was continued until full recovery.

RESULTS

No wound infections or septic complications were observed in any of the babies at either early (24-36 hours after the procedure) or late follow-up. Many subjects had an exudative discharge at the healing site several days after the procedure. This is a common finding associated with circumcision and was found to be nonindicative of infection.

CONCLUSIONS

This preliminary study suggests that strict sterile conditions are superfluous for ritual neonatal circumcision, and the effort and expense invested in maintaining an aseptic environment for this sort of intervention may not be justified. Further large-scale investigations are warranted to validate these findings and to determine if they can be extrapolated to other patient populations and other types of cutaneous surgery.