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Archive Infection Control 2014

A Preview of AORN's New Skin Prepping Guidelines

Let a growing body of evidence govern your bedside practice.

Sharon Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC


colored antiseptics A SIGHT BETTER Evidence supports the use of colored antiseptics, both to ensure complete coverage of the surgical site and to reduce the risk of fire.

Wouldn't it be great to say with 100% certainty exactly which skin preps and practices are going to do the best job of preventing surgical site infections? While that might not always be possible, there's plenty of strong evidence and evidence-based recommendations on which to base your prepping practices. Let's look at the strength and quality of each piece of evidence, along with how they relate to bedside practices, based on new prepping guidelines AORN is scheduled to release in July.

Pre-op showering
The evidence is strong that pre-operative bathing or showering is an effective way to reduce skin flora and that the benefits outweigh the harms (such as possible skin irritation or allergic reactions). Although it's intuitive to suggest that reducing transient and resident microorganisms on the skin reduces the risk that a patient will develop an SSI, there's not enough research to say that for certain.

Nor is there enough strong evidence to say that any one antiseptic is more effective than another for preventing SSIs. We do know that alcohol-based antiseptics may be more effective than those that are water-based, but other than that, the evidence doesn't clearly favor one over another. In fact, a Cochrane review of 13 randomized control trials concluded that the evidence for skin antiseptics is lacking quality, and that no conclusion could be reached as to which is the most effective skin antiseptic. That's not to say that it's impossible that one is more effective than another, but it's an unresolved issue that warrants further research.

As for the ideal number of pre-operative baths or showers, here, too, the evidence is lacking. Until more evidence becomes available, AORN will continue to recommend that patients be instructed to bathe or shower with either soap or a skin antiseptic on the night before or day of surgery. The bulk of available evidence suggests that using 2% chlorhexidine-impregnated wipes is an effective practice, but we also hope to see more high-quality research to confirm that.

Hair removal
The evidence in favor of leaving hair in place at the surgical site is strong. In one landmark study of nearly 24,000 surgical wounds, researchers found that patients who were shaved with a razor had a 2.3% infection rate, patients who had hair clipped had a 1.7% infection rate and those whose hair was left in place had a 0.9% infection rate (

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