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Archive November 2013 XIV, No. 11

Skin Preps: What's Your Standard of Care?

Remove the guesswork so you can defend your choice in surgical skin antisepsis.

Linda Greene, RN, MPS, CIC


skin prep NO ALCOHOL NEEDED? In clean-contaminated surgery, where skin flora is less of a concern, chlorhexidine scrub solution or plain iodophor may be adequate.

Could you defend your facility's choice in skin preps? It's harder than you might think, given the dearth of scientifically proven standards. The CDC has provided some guidelines based on expert consensus, but people are demanding more evidence. Until recently, even AORN shied away from making prep recommendations. Here are 4 evidence-based and common-sense recommendations about skin antisepsis that you can hang your surgical cap on.

1. Use alcohol, but safely
CDC guidelines support using an alcohol-based prep, but do so safely. Free-pouring alcohol is a fire risk because of its fumes and vapors. (Be wary of the doc who says: "I'm going to use some Betadine and then pour some alcohol, and that way, I've met the standards, so I don't have to use a product that contains both.") Let alcohol skin preps dry for 3 minutes; if it gets into really hairy areas, it can take much longer to dry. That's a safety concern, particularly in the presence of a source of ignition, like a cautery or a laser. There can also be a fire hazard if the prep area gets too wet and liquid pools underneath the patient.

2. Chlorhexidine with alcohol vs. povidone-iodine with alcohol
Which is better? Unfortunately, the initial studies haven't really compared them head to head, so this is an ongoing area of debate. I like the fact that the chlorhexidine with alcohol is very effective for a longer period of time than the alcohol-based prep with povidone-iodine. And many would argue that it's superior overall. The Institute for Healthcare Improvement is a huge proponent of chlorhexidine. I expect the new CDC guidelines to recommend a minimum prepping protocol of the night before and morning of a procedure. We probably don't have evidence yet to support beginning the prep 3 days in advance, but it makes some logical sense to do so.

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