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8 9 J U N E 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E es of prep and then place the foot or hand inside the bag. 6. Which antiseptic should I use for vaginal antisepsis? Which antiseptic should be used if the patient is allergic to povidone-iodine? This is a one of the most common questions we field. The collective evidence indicates that povidone-iodine is commonly used for vaginal antisepsis in gynecological procedures. 1 There are currently no FDA-approved (Category I, New Drug Application) antiseptic alternatives on the market for use in the vagi- nal vault when povidone-iodine is contraindicated (for example, a patient allergy). 1 The perioperative team members should collabora- tively evaluate the risks and benefits of using Class II or III FDA- approved antiseptics or other alternative solutions (soaps or saline, for example). 1 (See "FDA Categories of Patient Pre-operative Skin Preparations" on page 52.) Two alternatives to vaginal povidone- iodine, sterile saline 2 and baby shampoo, 3 were discussed in the liter- ature. Both studies suggest that these alternatives are as effective as povidone-iodine for pre-op vaginal antisepsis. In a position statement from the American Congress of Obstetricians and Gynecologists (ACOG), the committee recommends off-label use of 4% CHG with low alcohol content (4%) as a safe and effective alternative for vagi- nal preparation when povidone-iodine is contraindicated or CHG is preferred by the surgeon. 4 FDA Categories of Patient Pre-operative Skin Preparations 1 7. Should chlorhexidine (CHG)-impregnated cloths be used for pre-operative bathing? Undecided. A growing body of evidence supports the use of 2% CHG- impregnated cloth products for pre-operative bathing. CHG-impreg- nated cloths may increase the amount of CHG on the skin at the surgi- S U R G I C A L S K I N A S E P S I S OSE_1406_part2_Layout 1 6/13/14 11:41 AM Page 89