Archive April 2014 XV, No. 4

The Case for Standardizing Skin Preps

The opportunity to reduce infections is just one of several benefits.

Bonnie Zehr, RN


Mary Steiert, BSN, RN, CNOR


standardizing skin preps HANDS ON Standardizing skin preps is a way to empower pre-op personnel who are responsible for patient safety.

We prepare more than 3,000 patients a year for surgery, and one byproduct of all that activity was that some patients weren't having their skin prepped before they entered the OR. In other cases, they were prepped, but not as our physicians preferred. That was 2 years ago, before we volunteered to take part in the Institute for Healthcare Improvement Project JOINTS initiative. Now we're seeing the benefits that come from standardizing the skin-prepping process. Not that our infection rates were ever high — they weren't — but we wanted to get the rate as close to zero as possible. And when we looked closely at what we thought the obstacles toward achieving that goal might be, a lack of standardization was one that was high on the list. Now, in part because of the changes we've implemented, our infection rate is below 1% and we're seeing other benefits, as well.

Making the switch
We were fortunate that agreeing to a standard prep wasn't as difficult as it might have been. We're primarily an orthopedic facility (more than 80% of our surgical procedures are orthopedic) and naturally there was some back-and-forth, but most of our surgeons were already believers in chlorhexidine gluconate (CHG). Still, there were a few that we needed to find a way to convince. We'd asked our healthcare librarian to do a literature search of relevant randomized trials and meta-analyses, and when we showed the more reluctant surgeons the data and told them we were going to be participating in the Project JOINTS initiative, they all agreed to give it a shot.

Since then the feedback has all been positive. In fact, one of our surgeons was frustrated at the time because he'd been having some infections with the preps he'd been using. When we shared with him the evidence-based literature suggesting that CHG was better, he agreed to try it. Now, he's a CHG convert.

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