Nurses' Attitudes and Clinical Judgment on Skin Disinfection Before Subcutaneous Injection: Impact of Setting,...

Background/Objectives: Skin disinfection before insulin administration is widely regarded as essential for preventing injection-site infection. However, the World Health Organization advises that while hand hygiene and washing with soap and water are crucial, alcohol-based disinfection before subcutaneous injection is not required. Thus, the necessity for pre-injection (subcutaneous) skin preparation remains controversial. Therefore, this study aimed to clarify the determinants of nurses' attitudes toward the necessity of skin disinfection before subcutaneous injection. We simultaneously examined the effects of workplace setting, years of professional experience, and social norms to identify the most significant factors influencing clinical judgment. Methods: Nurses employed in wards, outpatient settings, and home care settings were surveyed between October 2021 and January 2022 in this cross-sectional study. A structured questionnaire assessed frequency of skin disinfection and attitudes regarding its necessity before subcutaneous injection. Ordinal logistic regression was performed to identify factors associated with the attitude of nurses. Results: Overall, 992 valid responses were analyzed. Ordinal logistic regression indicated that the attitude of nurses were significantly influenced by years of professional experience (Odds Ratio [OR] = 0.98, 95% Confidence Interval [CI] [0.96, 0.99]), normative expectations (OR = 2.88, 95% CI [2.32, 3.56]), and sanctions (OR = 1.36, 95% CI [1.15, 1.62]) (all p < 0.001). Conclusions: Nurses' beliefs regarding skin disinfection before subcutaneous injections are primarily influenced by normative expectations and professional experience, rather than workplace environment and experiential expectations. Experienced nurses do not disregard norms: they practice greater critical and situational judgment and show understanding of the purpose of disinfection.