5 2 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E M A Y 2 0 1 5
combined chlorhexidine and isopropyl alcohol paint, a combined iodine
povacrylex and isopropyl alcohol paint, and a 2-stage povidone-iodine paint and
scrub. The first 2 products have been compared head-to-head in 3 small ran-
domized controlled trials that, due to their size, had to employ skin decontami-
nation outcomes as a surrogate marker for SSIs. Intuitively this makes sense,
but it's unclear what amount of decontamination translates into a decrease in
surgical site infections, so these trials give us very limited information on which
of the 2 alcohol-containing products are most effective.
An industry-funded study published in the New England Journal of Medicine
(osmag.net/D4jHtO) in 2010 garnered much attention for touting chlorhexidine
and isopropryl alcohol over povidone-iodine as tested on patients undergoing
elective, clean-contaminated abdominal, thoracic, gynecologic and urologic sur-
In an effort to better protect its patients from surgical site infections, West Virginia University
Health Care formed interdisciplinary teams to assess potential risk factors and take multi-
modal action against them. The resulting quality improvement initiative was presented as a
poster at AORN's Surgical Conference and Expo in March (osmag.net/X0LdIy). Jesse Hixson,
MSN, RN, CNOR, an OR manager at WVU Health Care, oversaw the project's skin antisepsis
arm and offers the following thoughts on pre-operative preparations.
• Focus on technique. Antiseptic skin prepping is "the last chance you have before you make the incision
to get as much bacteria as possible away from the site. It's one of the most important things a nurse does in
the OR, a practice where they have a chance to affect surgical outcomes," says Mr. Hixson. "But you'd be sur-
prised at how many variations people put into their own practices. If someone has bad technique, they're
bringing a breach in sterility to the surgical table."
• Narrow the options. Standardize your skin prepping techniques and make sure you're following
manufacturers' instructions for use for each antiseptic agent, particularly how much to use and the manner
in which it is to be physically applied. "The most common problem is not using the product in the way it
was intended, specifically not allowing it to dry," he says. "You have to let it have time to dry to reach
antimicrobial efficiency," not to mention for fire safety when using alcohol-containing preps.
PREPPING POINTERS
Skin Antisepsis Done Right
