epidemiologist and director of infection prevention and control at UT
Southwestern. "In fact, they were performing those basic prepping
steps correctly in less than 50% of observed cases."
Dr. Arocha says these results are on par with national averages, sug-
gesting improper prepping is a problem in ORs across the country,
possibly even yours. The essential first step to improving prepping
practices is to get out from behind your desk, slip on some scrubs and
observe your surgical team in action.
1. Audit application
Audit your staff's compliance with a prep's specific application
method, application time and dry time, says Barbara Hasnain, BSN,
RN, CIC, an infection preventionist who was involved in most of the
staff observations conducted at UTSW. She says the application mis-
takes she saw were consistently inconsistent, and varied based on
prepping product and across service lines.
There were, for example, significant variances in how staff per-
formed the 2-step scrub and paint application process of povidone-
iodine preps. Ms. Hasnain also noticed that staff achieved the required
30-second application time for CHG-alcohol preps during only 6% of
cases, missing the mark by an average of 15 seconds.
"Nurses were applying the solutions based on surgeon preference or
how they were originally trained, however long ago that might have
been," she says. "Even if staff had originally been instructed on proper
application techniques, drift happened over time and they became lax
in their practice."
Ms. Hasnain saw the issues firsthand, and huddled with her col-
leagues to formulate a plan on how to address them.
2. Limit the options
6 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 9