Take, for example, alcohol-based CHG, our most commonly used
antiseptic agent. When applying this prep, you start at the incision
site and work your way out toward the periphery, doing a back-and-
forth friction scrub for a minimum of 30 seconds for dry surfaces (2
minutes for moist areas), and making sure you don't reverse back
toward the incision because it could spread contaminants. You also
need to consider the size of the body part you're prepping and how
many solution sticks you'll need to do the job. Too few and you'll
wind up with insufficient coverage; too many and you'll have pool-
ing.
Last but not least is the dreaded dry time. Alcohol-based prep solu-
tions require a minimum dry time of at least 3 minutes before draping
to not only prevent surgical fires, but also to reduce the bacterial
load on the skin. Let me tell you, the dry time struggle is real. For a
surgeon, 3 minutes in the OR is like a year-and-a-half. As a surgical
facility leader, you need to continually reinforce the necessity of
waiting the full 3 minutes. We've made it part of our timeout and our
fire risk assessment. When our circulator does the prep, she verbally
calls out when the prep is dry. If for whatever reason the surgeon
didn't wait the 3 minutes, it gets called out and is noted as a deficien-
cy in the time out. Depending on your culture, you may also want to
set a timer. I know several facilities that do this, and it's quite effec-
tive.
3. Audit and educate accordingly.
It's difficult to ensure your
staff is following your prepping standards without having a system
in place to verify it. That's why periodic audits are a facility's best
friend. It doesn't have to be complex or time-consuming; you just
need to periodically check in to make sure nothing's amiss. When
skin prep is on our list, we conduct quarterly back-to-basics audits.
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