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G U I D E L I N E S
Unexpected benefits
Though the evidence may not be 100% conclusive, it's definitely there, says Dr. DiGioia. "That's what it came down to," he says. "There is science behind it. There's more peer-reviewed literature for the alcohol-based preps than there is for the other parts of the bundle (pre-op bathing with CHG soap for 3 days and MSSA/MRSA screening)."
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Using alcohol-based preps is backed by peer-reviewed literature.
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Beyond taking a hard look at the evidence, a team-oriented approach was essential, he says: "The surgeon can't just walk into the OR one day and say, 'I'm going to start using alcohol-based preps.' It has to involve the whole OR team.
So part of our strategy was to engage each person — the circulating nurse, the scrubs, the PAs, the surgeons, the residents — in the whole process. It's important to make it a conversation, rather than just having one person mandate it.
"The other strategy we used was to always view all care through the eyes of patients and families. Focusing on what's best for the patient often removes the defensiveness about change. It's no longer a question of what the surgeon is saying, or the scrub tech or the PA. It's What's best for the patient?"
Once the transition was underway, the team got some pleasant surprises: "There were a lot of practical benefits that we didn't think about, but we found helpful," says Dr. DiGioia. "One was a huge improvement in efficiency. We all used different preps before. Now, having every surgeon do the same thing — that's a huge help for our OR staff. Also, the application is very efficient in that you literally paint the area with the prep and the paint has a teal color, so you can see exactly where you've prepped and where you didn't prep. That also minimizes pooling, which is always a concern with alcohol."
