Home Forums Discussions General Discussion Vaccines and Bandaids

OK, I am going to be particularly vague so as not to bias anyone.

When giving shots especially to a six month old or a toddler when you have to give multiple shots such as four, can everyone tell me their protocol as to gloves, gauze, alcohol swabs, bandaids, when and how you open bandaids.

Where do you draw up your shots and how do you carry all of the above to the room?

If this is too cryptic, I will explain more. After 15 years, this is the first complaint of this nature, so I want to get feedback from others. Of course, this was the first actual feedback we received. Others may have just left.

Would love to weigh-in on this one, Bert, but I cannot. All I can say is "what kind of animal would stick a 6 month old with needles"!
Reading between the lines: I think you have done this often enough to know that you are doing it right, without needing to ask for confirmation.

Thanks, but that isn't quite the point. I was hoping to get a few more pediatricians to weigh in. Even if it's, we do it the same way, but yes, we had three people complain.

Can't help much except to say I read recently that multidose vials should be stored in nurses station and have med drawn up in nurses station then taken to room. The thinking is that one would be less likely to introduce a used needed back into a multidose vial. (as you know there have been many cases of Hepatitis C transmitted this way)

It seem like when I was in med school, we were taught to have the multidose vial right next to the patient so you could draw up the med right before the patient and be less likely to make a wrong med / wrong patient error.

You can tell you're an internist. We already have three screaming kids before we even get in the room. I can't imagine drawing up the vaccine in front of them.

OK, so I will just give the scenario. I just wanted to get some feedback without bias.

This has never occurred in 15 years. We have fairly small black baskets about 1/3 the size of a shoe box. Our MAs draw up the shots and mark what vaccine it is. They also add a two or three 2 x2 gauze pads, alcohol swipes and bandaids prepared for the injection site. Since, the bandaids generally need to be applied quickly after the vaccination to 1. cover the site so blood isn't seen, 2. to be done with the process, and 3. Most shots for kids up to age five are given in the lateral thigh, and the parent wants to pull the pants back up; the MAs want them ready.

It is therefore, not efficient to give the shots and then open the bandaids to put them on. The bandaids are removed from their paper enclosure, the strips are removed, and the tip of one of the ends are placed on the outside of the basket.

At this point, the MA is completely ready to give the shots. In pediatrics, you want everything ready to minimize the amount of time the child has to get worked up over the shots.

For years, the shot is given after the skin is cleaned with an alcohol wipe, any blood at the site is dabbed with the gauze (not sterile), and the bandaid is placed over the injection site. The ends do not touch the injection site.

I then received an anonymous letter five days later from the parent who was EXTREMELY upset at the use of a CONTAMINATED bandaid on the wound. She stated she would have stopped this when she saw it occurring, but she had "too much on her mind."

To be honest, I don't even know why we use bandaids, it's not like it bleeds heavily. The kids do like the cartoon bandaids, however.

In 18 years of practice, I have never seen a vaccine site get infected. A circular, erythematous and very warm reaction, yes. And, I have never seen an infection due to a contaminated bandaid.

Any thoughts? Willing to be corrected. And, OSHA does not require the use of gloves except under certain circumstances.

Bert, use the letter for dart practice. And by the way, if I remember correctly from my last reading of Dante's "Inferno" there's a special place in hell for those who write nasty anonymous letters. They have to stand buck naked on a raised platform illuminated with flood lights and address all the assembled minions of the deep. They have to publicly read a recite every sin they ever committed. Then the "New Hades Times" publishes the story on the front page the next morning.
:-)

Amazing. Surprised that the parent didn't also complain about you injecting the kid with "mercury preservative causing autism"

I don't have pediatric kids who cry, but i do have some fibromyalgia adults who complain of severe pain with an injection of insulin Subcut in abdomen with 31 gauge short 5mm needle. Give me a break!

We do pretty much the same as you.

Shots are drawn up in the nurses station. The bandaids are attached to the side of the tray.

I have had a couple parents complain because they did not see it drawn up. I point out the anxiety it causes and they shut up.

I have not had an issue with "contaminated bandaids" either as a complaint or infected sites. Yes, you will sometimes get erytema but not cellulits.

Damn, you guys are great. John, you should have been a lawyer. (Sorry).

I really think I should dismiss this patient, especially given I have never dismissed an anonymous patient. I'm just trying to be careful as this is a board-happy state.

I am not sure I would even consider a vaccination a completely sterile procedure. It isn't like we clean the area with betadine three times and allow to dry before the injection.

In the interest of obtaining the best information, I would like to post the letter at least temporarily. I should say that this particular MA opens the bandaids while in the room and sticks one end to the table. I like the other way better.

The letter:

Dear Dr. Adams

I was in recently with my children to get their flu shots. As the person prepared to give each of them a shot, she opened each bandaid and stuck it to the table. At the time I witnessed this, I had several things going on in my mind and did not speak up.

I work in the healthcare field and am shocked that this type of procedure would even occur. I am also very bothered that these "now contaminated" bandages were put on my children where they just received a shot.

Please reconsider your process! It would be much appreciated and next time I come in with my children to receive shots, I will speak up!

Signed,

Concerned

Except for the popcorn button, microwaves have not come very far in the past 20 years. And, since the day of the red thread you were supposed to somehow pull down the side of the bandaid to open it, bandaids have made little improvement either. While it is possible to apply a bandaid without ever having touched the gauze or adhesive, it is next to impossible.

I would defy anyone to open and apply eight bandaids "steriley" to a six month old and a five year old in rapid succession.

Wouldn't you be more likely to introduce bacteria into a phlebotomy site? Because the last time I remember, they simply wipe the area with an alcohol swab, insert the needs directly into a vein, then grab an opened 2 x 2 inch gauze, fold it in half and have you hold it while they apply a bandaid.

Current Bandaids are from hell. I have recently spent substantial time bleeding all over the floor trying to get one open. This was followed by applying a used handkerchief until I could get one open. Oddly enough, I avoided sepsis. I doubt it was because of the sterility of the Bandaid.

As to the letter, the parent was probably one of the group mailing chickenpox infected lollipops to one another. Those things are always galling, like the driver who cuts you off and gives you the finger because he perceives you are driving too slowly. The world if full of idiots. Don't change a working system to accommodate them.

Must have been the Triple Antibiotic.

I usually just stick the one opened end on my chest. Wonder what Mom would have thought about that?

Depends on what you were wearing.

Actually, it was my 40 year old bottle of merthiotlate.

Oh, yes, the one you rub mercury directly into the wound. My mother did that all the time.

Hey..I have one of those too!! And silver nitrate sticks that are at least 20 YEARS old.

God, you should see our pseudo-sterile technique with urine straight caths.

We used to be sterile as hell, but it go so frustrating to cath a two month old, hold them down, get perfect visualization of the urethra (not always easy especially since the parent seems to think that my standing there is causing the crying) only to lose site of everything when you clean the area three times with Povidine sticks.

There are two interesting points here:

One is, if she had just made an appt to come in and talk (anonymously, of course), I would have heard her out and we could have come up with a plan for her kids and bandaids. I am always open to hearing out patients in a professional, mature conversation.

Two, one of her children has Alport's disease. Her last doctor (pediatrician) managed it, even though there was a pediatric nephrologist an hour away. It has been years since she followed up with them.

Well, Bert, you know what they say to do with them if they can't take a joke.

I have had all the fun I can stand for the evening. I'm going to go watch the last Harry Potter video, since I missed it at the theater. Read the book, tho, and I must say I'm sort of anxious about it all. Now, THERE is a problem worth agonizing over...

Have a good movie, David.

While you told me this scenario on the phone the other night, my thoughts are:

1) fire the family
it's not possible to give unbiased care to someone who is so petty as to complain in an annonymous letter, and to complain about something so incredibly stupid.
2) before you fire that family, bring them in for immunizations and don't use bandaids at all.
3) your MA could have spit on the wound, stuck the baby with a dirty needle, or put the injection in her eyeball. So that mother really needs to save her complaints for something really legitimate. it's like the boy who cried wolf, bitch too much and sooner or later everyone stops listening.

Oh, yeah, I forgot. She did spit in the wound.

On a serious note, I do think I should dismiss the patient. There actually is no set amount of days in Maine, although everyone always thinks it is 30 days.

Given the child with Alports disease, in order to avoid an abandonment case, I think I should give 90 days, not that she ever comes in. It would be a moot point as I imagine she would find another, more sterile environment to take her kids before 90 days were up. I should definitely scan her letter in as part of the chart (would everyone agree) so that it goes with the records; or is that not a good idea?

I would fire them. Of course I fire patients all the time because basically when I was in residency I had to see everyone no matter what and many times the patients would be nasty to me or the staff. That equaled a bad work environment. Now that I'm in practice myself, I keep an awesome work environment. If someone is even remotely nasty to me or my staff they get the walking papers. Plus Bert, you can tell them they can go and see the person who replaced me at the Walmart clinic! I would scan the letter into the chart too Bert.

lol, I remember in residency when a patient's mother kept riding me hard because her son had mono and was fatigued and I wouldn't do anything about it. Since I couldn't dismiss her, I decided it was time to have a frank discussion about good old American free market economics. I said, " Mam, I'm not sure if you know this or not, but we live in America which is build upon the capitalist system of free market economics. That means that if you are not happy with the care your child (who I think wasn't even a child, he was like 19 so your man child) is receiving from me, you are free to take your business elsewhere. I know that if I were not happy with say, the way my barber cut my hair, I would not go back there, I would go somewhere else." Oh man, she turned sooo red and was pissed! lol Of course the son didn't seem to care at all, he was staring at the wall probably dreaming about going home and playing some video games. Did she leave? Nope, kept coming back and calling and complaining about his mono.

That's hilarious. Actually, I plan on doing just that. I should challenge her to come in and put four bandaids on a five year old in under two minutes. I guarantee you she couldn't do it.

It's damn near impossible opening one period. Or I will challenge her to find one case in the literature where someone became septic from a contaminated bandaid.

It still kills me that she had so much going on in her mind, she couldn't say anything.