Journal of Clinical and Diagnostic Research. 2012 August, Vol-6(6): 1041-1046 1041 1041 ID: JCDR/2012/3968:2321 Original Article The Skin Preparation Knowledge, Attitudes and Practices among the Healthcare Professionals in Compliance with the World Health Organization (WHO) Guidelines Key Words: Skin preparations, Clinical practices, Injections, Healthcare, Knowledge survey ABSTRACT Objective: To evaluate the knowledge, attitudes and the practices of healthcare professionals towards the skin preparation before giving injections. Methods: Cross sectional study. A pre-tested, pre-designed, well-structured questionnaire which was written in English was administered to the volunteer doctors, pharmacists and the nurses at Penang General Hospital during 20th March 2011 to 20th April 2011. A total of 136 anonymously completed questionnaires were returned to the investigator. The data was analyzed by using SPSS-16 and the results were expressed as counts and percentages. Results: Most of the respondents derived their knowledge from healthcare personnel (70.5%, n = 136) and medical books (44.1%, n = 136). Most of the healthcare professionals knew that an alcohol swab would not minimize the pain either during (70%-85%) or after (55%-80%) an injection and that it would not minimize the risk of bleeding (50%-82%) after an injection. Almost all the respondents (93.7%) were of the view that not using a swab was not time saving and economical. However, more than 95% thought that skin preparations would minimize the risk of an infection; therefore, they would not administer an injection without using an alcohol swab. Conclusion: The knowledge on the use of an alcohol swab before giving intra-dermal, subcutaneous and intra-muscular injections was poor. The healthcare professionals believed that skin preparations would minimize the risk of an infection and that an injection could not be given after cleaning the site with soap and water. INTRODUCTION Injections are among the most common procedures which are used by healthcare professionals throughout the world. There is a general reluctance among people to accept injections without the site being cleaned with an alcohol swab [1,2]. According to the World Health Organization, there is no need to routinely use a 60%-70% alcohol swab for skin preparations before giving subcutaneous, intra-dermal and intra-muscular injections [3]. For the purpose of this survey, the term ‘injection’ refers to intra- dermal, intra-muscular and subcutaneous injections and to assess the knowledge awareness about the latest World Health Organization Guidelines 2010. In the medical care, an injection is the introduction of a drug, con- traceptive, vaccine or another therapeutic agent into the body by using a needle and syringe. Injections are among the most common healthcare procedures which are used throughout the world. According to the World Health Organization [4], among the best infection control practices, eliminating unnecessary injections is the highest priority in preventing injection-associated infections and when the injections are medically indicated, they should be administered safely to protect the patients, providers and the communities. Dann [5], in his six years of study, gave 5000 injections to unselected patients by all routes, from the intra-dermal to the intravenous routes, without using any form of skin preparation, without a single case of infection, either local or systemic. He suggested that a routine skin preparation may have unpleasant side effects. Yoshika Kazuaki [6] and colleagues compared distillate water cotton with an alcohol swab as a skin preparation before a vaccination, and found no infection in both the groups. The side effects of using swabs were more frequent among the alcohol swab users. Sutton, White, Edwards and Lewis [7], in their study, found only two cases of local infection at the venepuncture site. Both the patients were disinfected with Isopropyl Alcohol (IPA) and, interestingly, both the patients were on steroid therapy for chronic obstructive airways disease. Pus swabs subsequently grew Staphylococcus aureus in both the cases. The IPA skin disinfection did not prevent a local infection in either case, thus suggesting that IPA is an ineffective agent. According to the recommendation of the World Health Organ- ization (WHO), swabbing of the clean skin before giving an injection is unnecessary. The WHO further states that wash the skin that is visibly soiled or dirty? If swabbing with an antiseptic is being tried, then a clean, single-use swab should be used and a product-specific, Health Management Section MUHAMMAD QAMAR, SYED WASIF GILLANI, SYED AZHAR SYED SULAIMAN