A 50-year-old vaginal hysterectomy patient has an allergy
to povidone-iodine. Which prep solution is an appropriate
alternative?
a. baby shampoo
b. soap-saline mix
c. 4% chlorhexidine
d. all of the above
Answer: d
Many surgical teams are faced with this scenario quite often and there
is no FDA-approved alternative product to povidone-iodine for vaginal
prepping, says Lori Benton, RN, an infection preventionist at Tri-State
Memorial. Research has shown that sterile saline and baby shampoo
are as effective as povidone-iodine in prepping hysterectomy patients.
Ms. Benton says staff at Tri-State Memorial use a mild soap combined
with saline solution.
Although CHG labels warn specifically against using the products in
the genital area, the American College of Obstetricians and
Gynecologists published a position statement in 2013 that notes 4%
CHG with 4% IPA is well tolerated and may be used off-label to pre-
pare the vaginal area for surgery (osmag.net/8npquf). The statement
also mentions that 4% CHG with 70% IPA should not be used for this
purpose in order to avoid skin irritation.
Ms. Benton says your care team and infection preventionists must
ultimately confer to decide which prepping alternative is best for
these patients, based on a literature review and manufacturers'
instructions for use and contraindications.
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