A Coroner’s report into the death of a woman a few days after she was given a routine injection has caused consternation among general practice nurses.
While the inquest verdict into the death of Patricia Lines was accidental death, Rebecca Sutton, the assistant coroner in County Durham, concluded that the ‘failure’ of the practice nurse to clean the patient’s skin with alcohol prior to administration of the B12 injection contributed to the patient’s death.
In her Prevention of Future Deaths Report, the coroner said the nurse gave evidence that she did not clean the skin prior to administering the injection because she was ‘following both her training (she quoted from an NHS e-learning module on administering intramuscular injections) and national guidance in the Green Book’, which clearly states that ‘if the skin is clean, no further cleaning is necessary. Only visibly dirty skin needs to be washed with soap and water. It is not necessary to disinfect the skin.’
She stated: ‘The evidence that I heard at the inquest included that alcohol wipes are relatively cheap and their use does not give rise to any significant risk. I note that the Green Book states that cleaning the skin with alcohol reduces the bacterial count.
‘Common sense would seem to suggest that reducing the bacterial count would reduce the risk of bacteria being inadvertently introduced into the deeper tissues during an injection. Whilst it is noted that the Green Book also makes reference to there being evidence that disinfecting makes no difference to the incidence of bacterial complications, it is also noted that the literature quoted is now over 20 years old.’
Mrs Sutton, a civil law barrister specialising in inquests, personal injury and clinical negligence, added: ‘In my opinion action should be taken to prevent future deaths’.
A response from the UKSHA and NHS England to the report is due by 20 December 2024, but meanwhile, nurses have reacted angrily on social media, saying it is ‘nonsense’ and expressing sympathy for ‘the nurse who was only doing her job and following the guidance that we are all taught to follow’.
One nurse commented ‘We [need] evidence-based practice not a reflex to one unfortunate death that a single coroner (who [doesn’t] have medical training) has chosen to comment on’.
In a blog published by the Health Academy, travel health and immunisation specialist nurse Alys Bunce wrote: ‘There are clearly arguments for and against using alcohol swabs prior to injections. While alcohol swabs have long been part of the infection control process in many clinical areas, evidence suggests they may not be necessary for every injection, and even detrimental on occasion too, especially when the skin is clean. Clinical judgement is preferred to the “common sense” approach that the coroner argues for. Before the days of evidence-based practice we might well have relied upon misplaced thoughts about “what seems the right thing to do”. Nursing now goes way beyond being a “common sense” profession.’
