Clean versus sterile technique for common joint injections: a review from the physiatry perspective

Jennifer Baima, Zacharia Isaac, Jennifer Baima, Zacharia Isaac

Abstract

Preparation of the skin prior to joint injection varies widely among disciplines and across regional borders. This is likely due to the paucity of literature on the most effective and efficient methods of preparation. There is no standard definition of clean technique prior to joint injection. Review of the available literature suggests that alcohol is effective preparation for the skin prior to most procedures. Surveys of current clinical practice demonstrate that the use of gloves may be favored, but no conclusions can be drawn in regards to whether sterile gloves are required. Clean technique should be defined as use of non-sterile gloves and agents such as alcohol or soap prior to injection. Significant cost savings may be achieved with the consistent use of clean technique for preparation of the skin prior to joint injection. Further study should address the incidence of iatrogenic bacterial arthritis following clean technique versus sterile technique for joint injection.

References

    1. Pearce BA, Miller LH, Martin MA, Roush DL. Efficacy of clean v sterile surgical prep kits. AORN J. 1997;66(3):464–70. doi: 10.1016/S0001-2092(06)62691-4.
    1. Venes D. Taber’s cyclopedic medical dictionary. Philadelphia: FA Davis Company; 2005.
    1. Wooten MK, Hawkins K. Clean versus sterile: management of chronic wounds. WOCN Position Statement. January 2005.
    1. Occupational and Safety Health Administration Regulations: Occupational Safety and Health Standards, Toxic and Hazardous Substances, 1910.1030. . Accessed 1 Feb 2007.
    1. Cawley PJ, Morris IM. A study to compare the efficacy of two methods of skin preparation prior to joint injection. Br J Rheumatol. 1992;31:847–8. doi: 10.1093/rheumatology/31.12.847.
    1. Ryan MJ, Kavanagh R, Wall PG, Hazleman BL. Bacterial joint infections in England and Wales: analysis of bacterial isolates over a four year period. Br J Rheumatol. 1997;36:370–3. doi: 10.1093/rheumatology/36.3.370.
    1. Charalambous CP, Tryfonidis M, Sadiq S, Hirst P, Paul A. Septic arthritis following intra-articular steroid injection of the knee – a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee. Clin Rheumatol. 2003;22:386–90. doi: 10.1007/s10067-003-0757-7.
    1. Haslock I, Macfarlane D, Speed C. Intra-articular and soft tissue injections: a survey of current practice. Br J Rheumatol. 1995;34:449–52. doi: 10.1093/rheumatology/34.5.449.
    1. Ritter MA, French ML, Eitzen HE, Goie TJ. The antimicrobial effectiveness of operative-site preoperative agents: a microbiological and clinical study. JBJS. 1980;62:826–8.
    1. Kalantar-Hormozi AJ, Davami B. No need for preoperative antiseptics in elective outpatient plastic surgical operations: a prospective study. Plast Reconstr Surg. 2005;116(2):529–31. doi: 10.1097/01.PRS.0000142438.39280.3F.
    1. Meier DE, Nkor SK, Aasa D, OlaOlorun DA, Tarpley JL. Prospective randomized comparison of two preoperative skin preparation techniques in a developing world country. World J Surg. 2001;25:441–3. doi: 10.1007/s002680020073.
    1. Yood RA. Use of gloves for rheumatology procedures. Arthritis Rheum. 1993;36(4):575. doi: 10.1002/art.1780360421.
    1. Pal B, Morris J. Perceived risks of joint injection following intra-articular corticosteroid injections: a survey of rheumatologists. Clin Rheumatol. 1999;18:264–5. doi: 10.1007/s100670050098.
    1. Farooq MA, Devitt AT. Perceived efficacy and risks of infection following intra-articular injections: a survey of orthopedic surgeons. Ir J Med Sci. 2005;174(1):26–32.
    1. Kaandorp CJE, Dinant HJ, Laar MAFJ, Moens HJB, Prins APA, Dijkmans BAC. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997;56:470–5.
    1. Package insert, available at , Medline Industries, Inc. Mundelein, IL 60060 USA. Accessed 1 Feb 2007.
    1. Workman ML. Comparison of blot-drying versus air-drying of povidone-iodine cleansed skin. Appl Nurs Res. 1995;8(1):15–7. doi: 10.1016/S0897-1897(95)80253-3.
    1. Seror P, Pluvinage P, d’Andre FL, Benamou P, Attuil G. Frequency of sepsis after local corticosteroid injection (an inquiry on 1160000 injections in rheumatological private practice in France) Rheumatology (Oxford) 1999;38(12):1272–4. doi: 10.1093/rheumatology/38.12.1272.
    1. Nolan CM, Hashisaki PA, Dundas DF. An outbreak of soft-tissue infections due to Mycobacterium fortuitum associated with electromyography. J Infect Dis. 1991;163(5):1150–3.
    1. Harris ED, et al. Kelley’s textbook of rheumatology. Philadelphia: Elsevier Science; 2005. p. 698.
    1. Art G. Combination of povidone-iodine and alcohol formulations more effective, more convenient versus formulations containing either iodine or alcohol alone: a review of the literature. J Infus Nurs. 2005;28(5):314–20. doi: 10.1097/00129804-200509000-00004.
    1. , Bruce Medical Supply, 411 Waverly Oaks Road, Suite 154 Waltham, MA 02452. Accessed 1 Feb 2007.
    1. Online price catalogue available at . Accessed 1 Feb 2007.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe