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I N F E C T I O N
P R E V E N T I O N
shied away from making prep recommendations. Here are 4 evidencebased and common-sense recommendations about skin antisepsis
that you can hang your surgical cap on.
1. Use alcohol, but safely
CDC guidelines support using an alcohol-based prep, but do so safely.
Free-pouring alcohol is a fire risk because of its fumes and vapors. (Be
wary of the doc who says: "I'm going to use some Betadine and then
pour some alcohol, and that way, I've met the standards, so I don't have
to use a product that contains both.") Let alcohol skin preps dry for 3
minutes; if it gets into really hairy areas, it can take much longer to dry.
That's a safety concern, particularly in the presence of a source of ignition, like a cautery or a laser. There can also be a fire hazard if the prep
area gets too wet and liquid pools underneath the patient.
2. Chlorhexidine with alcohol
vs. povidone-iodine with alcohol
Which is better? Unfortunately, the initial studies haven't really compared them head to head, so this is an ongoing area of debate. I like
the fact that the chlorhexidine with alcohol is very effective for a
longer period of time than the alcohol-based prep with povidoneiodine. And many would argue that it's superior overall. The Institute
for Healthcare Improvement is a huge proponent of chlorhexidine. I
expect the new CDC guidelines to recommend a minimum prepping
protocol of the night before and morning of a procedure. We probably
don't have evidence yet to support beginning the prep 3 days in
advance, but it makes some logical sense to do so.
There's a slight drawback with chlorhexidine. Depending on skin
color, the prep can be very hard to see. Neither the orange nor the blue
colors are really vibrant on the skin. And some physicians ask, what is
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