I don’t know about you, but whenever I receive a vaccination at the drugstore or doctor’s office, I observe the ritual of the pre-injection alcohol swab and post-injection Band-Aid with wry humor. How many times have I vaccinated a dairy dog who smelled like money (if you know what I mean) or given Cerenia SQ to a ragged parvo puppy (or insulin to a likewise immunosuppressed diabetic), and not thought twice about alcohol or bandages?
Our daily work entails questionable patient hygiene, narrow windows of opportunity, densely haired skin, and aesthetic norms that do not include patchwork clip jobs for vaccine visits.
Which begs the question: If our patients do fine without these trappings, why is the human health standard so different? Is it due to First World societal expectations? To head off liability for the odd cellulitis or necrotizing fasciitis?
I have always assumed these were the major forces at work in this facet of human healthcare. And whenever I would quip to my needle-wielding medical compadres, “Thank goodness vets don’t have to use Band-Aids,” I only ever received a good-natured shrug and a laugh.
Herein lies the rub (?)
I will grant alcohol, being an antiseptic and all, ought to decrease bacterial counts on the skin and thus decrease the risk of cutaneous infection. But does it? To put a finer point on the question (pun intended), I vaguely recall a study years ago that documented more skin bacteria being dislodged and pushed into the subcutaneous space when the needle passed through alcohol-drenched fur than dry fur.
Plus, alcohol has a bona-fide nefarious side. An article in the journal, Human Vaccine and Immunotherapeutics,1 cites an increased incidence of injection-site pain in people pre-treated with an alcohol swab due to the alcohol tracking into the tissue alongside the needle.
The article goes on to describe a randomized, controlled trial of 170 Canadian children that found no increased risk of skin reaction or infection when vaccines were given through non-alcohol-swabbed skin. The authors conclude, “Cleansing the skin with alcohol may not be needed.” When was this study published? It was 2019.
Could it be veterinary medicine has been ahead of the curve this whole time? Well…the World Health Organization (WHO) guidelines do not require a pre-injection alcohol swab. However, the Centers for Disease Control and Prevention’s (CDC’s) 2021 Pink Book (i.e. its Epidemiology and Prevention of Vaccine-Preventable Diseases textbook, 14th edition), unapologetically and quite perfunctorily lists the alcohol swab as step two for all subcutaneous and intramuscular injections. Besides, 30 percent of Canadian parents in the trial above stated they were uncomfortable with a vaccine being given sans alcohol. So, societal and regional norms do, indeed, play a role.
Wrap it up
Enough about alcohol. Let’s mess with the Band-Aids. I may be a little more extreme than some of you in my view of the ubiquitous self-adhesive bandage of our day, but I have my reasons. I go hiking in the woods often and carry a snazzy, red-zippered first-aid kit in my backpack at all times. This commercial kit came chalk full of bandages—of every size—which I promptly tossed into a drawer to make room for the real stuff: packs of Telfa, partial rolls of vet wrap and Elastikon, a betadine surgical sponge. I even have an Israeli military issue compression bandage to round out my wound care supplies. Oh, and duct tape. Because, well, it’s duct tape.
I know if I get hurt out there, it is more likely to be a backcountry bear encounter than a paper cut. My only real use for a Band-Aid is to protect a skinned knuckle that keeps getting bumped and cracked back open. What gives with the post-vaccine bandage?
Turns out, it is standard medical procedure, not to protect the recipient from a post-injection staph infection, but to keep blood-borne pathogens, oozing blob-like in classic horror film fashion, away from the vaccinator. This humbling epiphany ripped my ego-centric world right out from under my feet. It’s not about me. It’s about them. And I am resolved to never make light of the post-vaccine Band-Aid again.
We all know it is a scary world out there in ‘Pathogenland.’ We veterinarians have it easy. Zoonoses are a subtopic in our infectious disease courses, not the infectious disease course itself. Whatever I can do to make life less scary for human health personnel on those fearsome front lines, I’m in.
Indeed, far from being relegated to the derelict pile, the post-vaccine bandage is actually getting an upgrade. Meet the inject-safe barrier Band-Aid. You may have run into this newcomer already. I have. At the time, I thought it was really weird. Yet, after researching for this article, I believe it will become the new gold standard for protecting human health providers. This Band-Aid is a quarter-sized circle of self-sealing membrane, ringed by a strip of adhesive, which is applied to the skin prior to the injection.
Sure, sure, these days in North America you will first receive the requisite alcohol swab. Then this bad boy gets pressed onto the skin and your health provider thereafter has both hands free to handle the syringe, give the injection, dispose of sharps, wax the Prius in the parking lot, and not worry one lick about the bleb of blood held back by the barrier bandage.
So, what can veterinary medicine learn from the “alcohol swab and bandage” routine of human vaccinations? First, sometimes human medicine can get lost in the ideal of what ought to make sense at the expense of practical sense, just like we can.
Second, the rise of evidence-based literature serves as an active course corrector for both human and veterinary medicine.
Third, while the intra-fur injection is an annoyingly constant possibility in our day, it is also a stark reminder the dangers to our own health are fewer and more easily seen than those faced by our friends in human healthcare. So, when you see that Band-Aid heading for your upper deltoid, smile and say, “thank you.”
Holly Sawyer, DVM, worked 19 years in small animal private practice before joining GuardianVets to train and coach the veterinary professionals who deliver 24-hour triage support to hospitals. In her free time, she snowshoes and hikes with her two dogs and bakes chocolate chip cookies, not always in that order. Writers’ opinions do not necessarily reflect those of Veterinary Practice News.
- Wong, H., et al. “Effect of alcohol skin cleansing on vaccination-associated infections and local skin reactions: a randomized controlled trial.” Human Vaccines and Immunotherapeutics. Jan 16, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605859/