The U.S. Centers for Disease Control and Prevention (CDC) estimates approximately 1.7 million patients per year develop healthcare associated infections. Surgery centers, and all healthcare providers, can implement a standardized surgical skin antisepsis protocol to promote improved patient safety. Sharon Butler, MSN, RN, a clinical nurse IV of Stanford (Calif.) University Hospital and Clinics and chairperson of the Perioperative Research Council at Stanford University Hospital, explains the difference between products used in surgical site preparation and how these products can be used in surgical patient preparation.
1. Know the most commonly used skin preparation ingredients. Alcohol, iodophors and chlorhexidine gluconate (CHG) are the ingredients most commonly found in skin preparation products. Alcohol is the most rapidly acting agent and acts through the denature of proteins. Iodophors are of intermediate action time and act through oxidation. CHG is also of intermediate action time and acts through disruption of the cell membrane. Of the three ingredients, CHG by far has the best residual activity and lasting power, says Ms. Butler.
2. Compare the available products. Commonly available skin antisepsis products include aqueous-iodophor, alcohol-iodophor, aqueous-CHG and alcohol-CHG. All of these products have antimicrobial coverage including gram negative and positive bacteria, fungi and viruses. Aqueous-iodophor products have persistent effects for two hours and aqueous-CHG products last for six hours. Both alcohol-based products persist for 48 hours.
Each product has a different process for application. Aqueous-iodophors are applied in two-step scrub and paint process. On the other hand, aqueous-CHG products are applied in a scrub, dry and repeat process. Alcohol-iodophor products are applied in a paint process, and alcohol-CHG products promote a gentle friction scrub to help the solution penetrate the skin.
3. Select the product that makes the most sense for your center. After understanding each product and its components, surgery center leaders can choose which makes the most sense for their center. In her experience, Ms. Butler found that the one-step CHG combined with alcohol was the most effective for skin antisepsis. "Focus on the evidence that supports the agents that are most effective for the procedures that you and your facility host," she says.
After surgery center leaders select the product that will serve as the basis for a center's standardized skin antisepsis protocol, nurses should review physician preference cards and custom supply kits to make sure that the product of choice is used throughout the facility.
4. Consistently review available products. The Centers for Medicare and Medicaid Services have initiated pay-for-performance and quality programs to encourage the reduction of healthcare-associated infections. This further encourages healthcare providers to focus on quality initiatives.
"Know that skin prep manufacturers are actively looking to change products to combat the issue of resistant organisms, so consistently review the evidence and commercially available preps to ensure your efforts remain current," says Ms. Butler.
This content is based on a webinar supported by CareFusion.
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