Alcohol, with or without antiseptic, for preparing the skin before blood collection to prevent bacteraemia or contamination of blood for transfusion.

When blood is collected from blood donors for transfusion it may become contaminated during collection, storage or transfusion. Blood contamination can cause bacteraemia (the presence of bacteria in the blood), severe illness or even death in the blood recipient. When blood is being taken from donors, the skin on the arm of the donor is one potential source of contamination, so it is usual to cleanse the arm with an antiseptic first, and both one-step and two-step alcohol based regimens are commonly used, however there is uncertainty about which regimen is the most effective for reducing the microbial load (the number of microscopic bacterial organisms) on the donor arm. We looked for studies that compared the use of alcohol alone versus the use of alcohol followed by another antiseptic to clean the arm before the needle is inserted to draw blood, but we did not find any relevant studies. It is currently unclear whether donor skin cleansing with a one-step alcohol based regimen reduces the risk of blood contamination compared with a two-step alcohol based regimen during blood donation.

Authors' conclusions: 

We did not identify any eligible studies for inclusion in this review. It is therefore unclear whether a two-step, alcohol followed by antiseptic skin cleansing process prior to blood donation confers any reduction in the risk of blood contamination or bacteraemia in blood recipients, or conversely whether a one-step process increases risk above that associated with a two-step process.

Read the full abstract...

Blood for transfusion may become contaminated at any point between collection and transfusion and may result in bacteraemia (the presence of bacteria in the blood), severe illness or even death for the blood recipient. Donor arm skin is one potential source of blood contamination, so it is usual to cleanse the skin with an antiseptic before blood donation. One-step and two-step alcohol based antiseptic regimens are both commonly advocated but there is uncertainty as to which is most effective.


To assess the effects of cleansing the skin of blood donors with alcohol in a one-step compared with alcohol in a two-step procedure to prevent contamination of collected blood or bacteraemia in the recipient.

Search strategy: 

In December 2014, for this third update, we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL.

Selection criteria: 

All randomised trials (RCTs) comparing alcohol based donor skin cleansing in a one-step versus a two-step process that includes alcohol and any other antiseptic for pre-venepuncture skin cleansing were considered. Quasi randomised trials were to have been considered in the absence of RCTs.

Data collection and analysis: 

Two review authors independently assessed studies for inclusion.

Main results: 

No studies (RCTs or quasi RCTs) met the inclusion criteria.