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Is skin disinfection before subcutaneous injection necessary? The reasoning of Certified Nurses in Infection Control in Japan.

Authors
  • Yoshida, Yuko1
  • Takashima, Risa2
  • Yano, Rika1
  • 1 Department of Fundamental Nursing, Hokkaido University Faculty of Health Sciences, Sapporo, Hokkaido, Japan. , (Japan)
  • 2 Department of Functioning and Disability, Hokkaido University Faculty of Health Sciences, Sapporo, Hokkaido, Japan. , (Japan)
Type
Published Article
Journal
PLoS ONE
Publisher
Public Library of Science
Publication Date
Jan 01, 2021
Volume
16
Issue
1
Identifiers
DOI: 10.1371/journal.pone.0245202
PMID: 33418557
Source
Medline
Language
English
License
Unknown

Abstract

Nurses continue to disinfect the skin before administering subcutaneous injections as a standard process in clinical settings; despite evidence that disinfection is not necessary. To implement evidence-based practice, it is critical to explore why this gap between "evidence" and "practice" exists. This study aimed to describe the reasons offered by Certified Nurses in Infection Control (CNIC) in Japan for performing skin disinfection before subcutaneous injection. Adopting an inductive qualitative design, interviews were conducted with 10 CNIC in 2013. According to the participants, skin disinfection before subcutaneous injection: (a) was common practice; (b) may have been beneficial if it was omitted; (c) adhered to hospital norms; (d) prevented persistent suspicion of infection; (e) had no detrimental effect; (f) was an ingrained custom; and (g) involved a tacit approval for not disinfecting in home care settings. The themes (c) and (g) were cited as the main reasons affecting decision-making. The CNIC administered injections following skin disinfection in hospitals in accordance with hospital norms. On the contrary, outside the hospital, they administered subcutaneous injections without skin disinfection. All themes except (b) and (g) reflect the barriers and resistance to omitting skin disinfection, while (g) shows that it is already partly implemented in home care settings. It is necessary to create a guideline for skin disinfection before subcutaneous injection that considers the quality of life of patients at home, their physical conditions, and the surrounding environment at the time of injection, in addition to the guidelines applicable in hospitals.

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