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"Make sure you have the tools and equipment staffers need before you try to
implement a new process," says Ms. Ripplinger. "Give them the rationale and
explanation of your hair removal protocol. It's easier if everything's done
upfront and if they know why they're doing what they're doing."
3. Skin antisepsis
Because surgeon preference often drives skin antisepsis decisions, it can be
hard to standardize the practice. But you can give surgeons free rein while
encouraging uniformity through education, says Ms. Ripplinger. She notes that
while her facility lets surgeons choose which preps they want to use, the over-
whelming majority use a CHG prep after learning how it dries quickly, is easy
to apply and is effective at eliminating microbes on the skin.
Dr. Saleh also says that a CHG-alcohol based solution was the most popular
skin prep included in his study, though he notes that other formulas backed by
clinical evidence can still be effective antiseptics — as long as they're applied
correctly. But that doesn't happen as often as you might think. Dr. Saleh, who
received funding from Carefusion and several other companies and organiza-
tions for the International Surgery study, notes that skin prepping practices at
almost 40% of the 257 hospitals his research team observed were non-compliant
with either the application or dry times of the skin preps they used, and only
25% were compliant with the manufacturers' directions for use.
His research team found a few factors that seemed to affect compliance rates
among all of the preps studied, which included CHG-, CHG-alcohol, iodine- and
iodine-alcohol-based preps. A single-step, CHG-alcohol solution applied in a
back-and-forth manner correlated with higher compliance. In addition, surgical
teams using an aqueous-chlorhexidine, iodine or iodine-alcohol prep, or those
performing 2 or more preps per patient, exhibited lower compliance rates. The
findings show that simplifying the prepping process may make it more likely
that staffers follow the directions and can encourage standardization among sur-
geons, suggests Dr. Saleh.
