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Archive February 2020 XXI, No. 2

Are You Applying Skin Preps Properly?

Address common reasons for noncompliance to reduce the risk of surgical site infections.

Romulo Vallejo

Romulo Vallejo, MSN, RN


David Reidy/CHOC
READY, SET, GO April Andrade, RN, BSN, stands ready to drape the patient as Tanya Muallem, RN, preps the patient.

Prepping the skin before surgery seems to be a simple matter. Apply the solution, let it dry and begin the operation with more confidence that the patient's surgical wound will emerge infection-free. But nationwide, experts say, prepping solution is applied correctly only about half the time. The best way to boost skin prep compliance is to focus on educating surgical team members about proper application techniques, standardizing the solutions you use and the process you've developed, and changing the culture in your ORs.

Rubbing the wrong way

In May 2018, we decided to take a proactive approach to improving our skin prep compliance rate. We audited 31 cases over a three-day period in order to establish our compliance baseline. To ensure an unbiased audit, we announced that we'd be observing OR practice in general, not skin prep in particular. We found our team adhered to manufacturers' IFUs for skin prep application in 45% of the cases, while meeting the dry time standard of three minutes in 52% of the cases. That was consistent with national benchmarks, but we wanted to exceed the national average. First, though, we needed to identify specific opportunities for improvement.

  • Knowledge deficits. We recognized that staff members weren't clear on how long application of the prep should be, and the length of dry time for each. We had an opportunity to remind clinicians of the need for and purpose of proper skin prepping as a best practice in the effort to protect against SSIs.
  • Multiple solutions. Before we started this project, we typically used three different skin prep agents. While all were effective, our OR nurses and techs were switching among the three depending on individual surgeon preferences, a lack of standardization that led to confusion regarding how each solution should be properly applied. To reduce that knowledge deficit and simplify our practice, we decided to standardize on a single skin prep solution for all of our surgeries, and educate staff members on its proper use.

There was also a lack of standardization in terms of who was prepping the patient. Sometimes it was a nurse; other times it was the surgeon.

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