M A Y 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 5 3
geries. The study left unanswered, however, whether it was the chlorhexidine or
the addition of alcohol that provided the superior effect.
Further confusing the issue, the observational data does not square with ran-
domized data. Non-randomized studies have generally found no antiseptic differ-
ences between chlorhexidine- and iodine-based products. One even found
iodine superior; however, it contained several flaws. For an effective compari-
son of prep effectiveness, the clearest answers will come from well-designed,
randomized controlled trials.
Skin preparation can even begin before the patient arrives in pre-op, in the
form of antiseptic bathing, showering or site-wiping (see "CHG Treatments
Begin at Home"). The evidence we have shows this practice effectively reduces
• Monitor practices. After educating your staff, audit their prepping performance.
"Don't assume anything," he says. "Healthcare providers should hold each other to
higher standards when it comes to antiseptic skin prepping."
• Gather data. The choice of prep is often based on physician preference, but a
review of clinical studies can offer pointers on which agent is best for which patient care
if you're looking to standardize the products you have on hand. "Engage the surgeons in the process or you
won't get buy in," he says. "Surgeons want to see evidence, if you're asking them to change their practices."
• Partner with patients. Instruct your patients to take part in their antisepsis. "We have an important rule:
Our inpatients do not come down to the OR without pre-op bathing or showering," says Mr. Hixson. "It's a
hard stop unless that's completed. For outpatients, if they have not taken an antiseptic shower, we direct
them to do it here."
• Do your part. Eliminate unnecessary OR traffic and have providers doing preps cover their arms to pre-
vent contamination from skin cells and hair. WVU's surgical managers are also looking to include single-use
gowns in a different color from standard surgical garb to its procedure packs in order to designate them as
the prepper and prevent distractions or requests for assistance. — David Bernard
z
SOLE SOLUTION
Different
prep-
ping agents may be differently
effective for different body parts
and before different procedures.
