M A Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 3
povidone-iodine solution manufacturers recommend a circular
application technique in which the product is applied from the least
to the most contaminated areas. Most CHG product manufacturers,
on the other hand, recommend a firm back-and-forth method of
application, though also from least to most contaminated area.
3. Hair removal is optional. The link between hair removal at the sur-
gical site and SSI risk is limited. Many of the studies performed on the
topic did not use standardized definitions of SSIs, were underpowered
and are roughly 20 years old. Where there is consensus is that hair
should not be removed with razors as the evidence clearly demon-
strates small microabrasions created in the skin increases the risk for
SSIs. Current recommendations from AORN and the CDC state that
hair removal should not be performed unless the presence of hair at
the surgical site will interfere with the procedure. If hair must be
removed, AORN recommends the use of clippers or a depilatory, while
the CDC preferentially recommends clippers. AORN emphasizes the
importance of removing hair outside the OR and with vacuum-assisted
clippers or wet clipping to avoid dispersal of loose hair particles.
4. Size matters. Both AORN and the Association for Surgical
Technologists recommend prepping an area that is wider than the
planned incision. This additional prepped space allows for unfore-
seen developments such as the need to extend the incision or create
an additional incision, the use of drains, or conversion of an endo-
scopic procedure to an open procedure. Additionally, following the
manufacturer recommendations for the maximal treatment area per
antiseptic applicator is key to avoiding inadequate skin disinfection.
— Helen Johnson, MD
