INDIAN PEDIATRICS VOLUME 34-DECEMBER 1997

Immunization Dialogue

Skin Preparation for BCG together BCG and alcohol, since the latter is a disinfectant and the former is sus- pension of live bacteria. In order to ensure this prohibition, different instructions may Q. According to Preventive and Social Medi- be given by different experts. Park's Text- cine Department guidelines, the site of book of Preventive and Social Medicine BCG should be wiped with states: "If alcohol is used to swab the skin, sterile water only and no antiseptic solu- it must be allowed to evaporate before the tion should be used for cleaning. The objec- vaccine is given"(l). This is precisely what tion for using antiseptic is that it may in- Dr. Tiwari practices and he quotes his terfere with the process. But personal experience of over 500 inocula- if antiseptic is not used then infective or- tions with no more than one per cent ganisms present on the skin, if any, are failure rate. bound to be carried into the layers of der- What does wiping the skin with a swab mis along with the bevel of the needle, thus containing spirit (70% alochol) or sterile interfering with immunization. I have been water, achieve? It removes mechanically using spirit to clean the site for BCG vacci- any organisms that have settled on the nation but allow it to completely dry up be- skin; the important ones eire spores of fore injecting the dose. With this technique, Clostridium tetani, Staphylococus aureus, etc. since many years I have come across. 'Vac- Alcohol also kills, by protein denaturation, cination failures' in not more than five or vegatative organisms such as S. aureus, or six cases out of more than five hundred im- the normal skin flora such as S. epidermidis, munized subjects. I solicit the comments of diphtheriods, etc. Although alcohol does not 1AP Immunization Committee on this sterilize the skin, it renders the skin safe point. enough to be pierced without fear of intro- Mukul Tiwari, ducing any pathogens. If the site has to be Child Specialist, sterilized, then iodine (in tincture form) is Apex Child-Mother applied, allowed time to act, and then ex- General Hospital and Research, cess removed by alcohol to prevent skin University Road, Thatipur, damage. Here the cotton must be pre-steril- Gwalior. ized, for obvious reasons. If blood is drawn for culture without sterilizing the skin site, then the normal skin-flora will contaminate A. How should we cleanse the skin site the culture. So, we may ask: is it safe to in- before BCG inoculation? Dr. Tiwari has oculate through skin which is cleansed cited one instruction, apparently from (only) with spirit? It is, since our concern is a Medical College Department of Pre- less with normal flora than with pathogens ventive and Social Medicine to use which might have settled on the skin. Even sterile water to wipe the skin; the use if a few normal flora are introduced under of any disinfectant, such as surgical the skin, macrophages will clear them; they spirit, is prohibited. are usually non-pathogenic. This is why The basic principle here is, not to bring some people give skin tests (prick test, tu-

1135 IMMUNIZATION DIALOGUE berculin test, etc.) Without any preparation REFERENCE of the site, and get away without trouble. 1. Park JE, Park K. Park's Textbook of Pre- T. Jacob John, ventive and Social Medicine 13th edn. Chairman, IAP Immunization Committee, Jabalpur. Banarsidas Bhanot Publishers. Emeritus Professor, 1991; p 137. Department of Clinical Virology, Christian Medical College Hospital, Vellore 632 004, Tamil Nadu.

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