Steroid injections are generally very safe, with serious complications being extremely rare. At Complete Injections patient safety is our priority and we take all steps to ensure any risks are minimised.
An infection in the soft tissue or joint is probably the most serious complication that can occur after a steroid injection. Thankfully this is very rare. Studies suggest that around one in every hundred thousand patients (1:100,000) who receive a steroid injection subsequently experience an infection at the site of the injection (Charalambous et al 2003, Holland et al 2012). Although rare, having an infection following a steroid injection, can be extremely serious and require immediate and urgent medical attention.
How can a steroid injection cause an infection?
Bacteria are found almost everywhere, including within the human body and on our skin.
Any object that penetrates our body can potentially take bacteria into the tissues, which can subsequently cause an infection.
Steroid injections have the added complication that corticosteroid is also an immunosuppressant and therefore increases the likelihood that bacteria or debris taken into the tissues of the body could potentially cause an infection.
There are also some medical conditions which may increase the risk of infection, such as pre-existing joint disease (especially rheumatoid arthritis), diabetes mellitus, the presence of prosthetic or osteosynthetic material, skin disorders or defects, advanced age, and use of immunosuppressive medication. These will be highlighted on the medical screening and consent form completed prior to your booking.
How do we minimise the risk of infection?
At Complete Injections we follow stringent guidelines around infection prevention and control.
All our rooms are cleaned regularly. All the surfaces and equipment are cleaned between each patient with approved anti-bacterial cleaning products. Prior to the injection, the surface of the skin will be thoroughly cleaned.
We use personal protective equipment (PPE), including apron, gloves, and mask to reduce the risk of any transmission of bacteria.
We strictly follow a ‘no-touch’ technique, which is the universally accepted guideline for injection procedures to minimise infection risk.
Following the injection, your therapist will clean and cover the area with a plaster.
You are advised to keep the injection site covered for 24 hours after the injection, ensuring that it is kept clean and dry.
If you are washing that evening, we recommend a shower rather than a bath, particularly if the area is likely to stay submerged in water (e.g., after a hip or ankle injection), to avoid any risks of bacteria around the injection site.
What are the signs of an infection?
Despite measures to minimise the risk of infection, it is still feasible, on very rare occasions, that an infection might occur.
We therefore advise all patients to monitor for potential signs and symptoms of infection, specifically:
- Red, hot, and swollen at the site of the injection
- Worsening pain
- A general feeling of being unwell, including nausea, temperature, and respiratory changes
- Dizziness or severe fatigue.
What should you do if you think you might have an infection?
If you are concerned that you might have an infection, it is essential that you seek immediate medical attention. We recommend attending an accident and emergency department as you will require a physical examination and tests to confirm diagnosis.
Inform the medical practitioner that you have received a steroid injection and show them the region of the injection.
Even if the area of the injection itself has not become red, hot, and swollen, but you are displaying signs of a possible infection (generally unwell, nausea, difficulty breathing), it is imperative that you inform the medical practitioner of the treatment and the location of any recent steroid injections so that they can investigate this as a possible cause of infection. Infections can get into the blood stream and therefore require urgent medical attention.
If you have any queries or concerns, do not hesitate to contact one of our team who will be able to advise you – injections@complete-physio.co.uk or call 02074823875.
References
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Charalambous, C.P., Tryfonidis, M., Sadiq, S., Hirst, P. and Paul, A., 2003. Septic arthritis following intra-articular steroid injection of the knee–a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee. Clinical rheumatology, 22(6), pp.386-390.
Holland, C., Jaeger, L., Smentkowski, U., Weber, B. and Otto, C., 2012. Septic and aseptic complications of corticosteroid injections: an assessment of 278 cases reviewed by expert commissions and mediation boards from 2005 to 2009. Deutsches Ärzteblatt international, 109(24), p.425.
Kaandrop CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum 38:1819–25
Murray, R., Pearson, J.C., Coombs, G.W., Flexman, J.P., Golledge, C.L., Speers, D.J., Dyer, J.R., McLellan, D.G., Reilly, M., Bell, J.M. and Bowen, S.F., 2008. Outbreak of invasive methicillin-resistant Staphylococcus aureus infection associated with acupuncture and joint injection. Infection Control & Hospital Epidemiology, 29(9), pp.859-865.
Nallamshetty, L., Buchowski, J.M., Nazarian, L.A., Narula, S., Musto, M., Ahn, N.U. and Frassica, F.J., 2003. Septic arthritis of the hip following cortisone injection: case report and review of the literature. Clinical imaging, 27(4), pp.225-228.
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Peterson, C. and Hodler, J., 2011. Adverse events from diagnostic and therapeutic joint injections: a literature review. Skeletal radiology, 40(1), pp.5-12.
Provenzano, D.A., Hanes, M.C. and Deer, T.R., 2018. Interventional Pain Procedures and the Risk of Infection. In Essentials of Pain Medicine (pp. 813-824). Elsevier.
Rosen, R.C., Stuto, A.C. and Cook, K.D., Group a Streptococcus Necrotizing Soft Tissue Infection Secondary to Corticosteroid Injection: A Case Report and Literature Review. Clin Surg. 2017; 2, 1431.
Stephens, M.B., Beutler, A. and O’Connor, F.G., 2008. Musculoskeletal injections: a review of the evidence. American family physician, 78(8), pp.971-976.
Von Essen, R. and Savolainen, H.A., 1989. Bacterial infection following intra-articular injection: a brief review. Scandinavian journal of rheumatology, 18(1), pp.7-12.
