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I N F E C T I O N
P R E V E N T I O N
iodine in pre-op preparations. Skin preps are not interchangeable
for any surgeries or sites. For example, CHG (with or without
alcohol) mustn't be used near a patient's eyes, ears or mucous
membranes, while povidone-iodine can be. An iodine-alcohol prep
might be better for general and abdominal surgery, where the
chief bacterial risk is gram-negative bowel flora, while CHG is
more effective against the gram-positive skin flora that bedevils
orthopedic cases. Povidone-iodine also serves as an inexpensive
alternative in the event a patient is allergic or sensitive to CHG.
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Alcohol makes a skin
prep product more effective.
True. Isopropyl alcohol has an immediate antimicrobial impact,
but it doesn't last long. Coupled with the residual effects of CHG,
though, it makes a strong contribution. Povidone-iodine has a fast,
broad-spectrum antimicrobial activity, but it's easily inactivated
through contact with blood, bodily fluids, tissue proteins or other
organic matter. "Even after letting Betadine dry, once blood enters
the scene, it's going to be ineffective," says Ms. Hanus. Alcohol,
however, isn't and can boost iodine's effects. As a result, there is a
general consensus, recently emphasized by the Institute for
Healthcare Improvement's Project JOINTS (tinyurl.com/otmkt4w),
that no matter which type of prep you're using, alcohol should be
a part of it. Unless, of course, you're prepping an area where alcohol is not tolerated, such as around the eyes or mucous membranes.
Because alcohol is a flammable substance, it's also imperative
that it's completely dry before the patient is draped and surgery
begins, and that it not pool on or beneath the patient.
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