EBT1 Task 3
When a patient is getting ready for surgery, one of the last things on their mind is infection. As medical personnel though, it is a thought that definitely does not leave the mind. Getting an infection after surgery not only increases a patients hospital stay and recovery time, but also increases expenses for the hospital. When thinking of ways to decrease infection, it most often starts with preparation of the surgical site and insertion of invasive catheters. When cleaning the site, many institutions continue to use beta dine though research shows that Chlorhexidine has better results. Though Beta dine and Chlorhexidine both reduce bacterial count, Chlorhexidine is found to be more profound and longer lasting (Jarral, McCormack, Ibrahim & Shipolini, 2011). A2.
a. Currently betadine is being used when preparing the surgical site at the institution being examined. When attempting to figure out who made the decision for the way skin is prepped, it is unknown. Though to change the current practice, the nursing practice council will need to show evidence supporting the change. Once that is done, it may be brought to the nurse manager in the OR and up to administration to help facilitate a change. Once the change is approved, it is up to nursing leadership to show a good example and educate the current nursing staff on the importance.
b. Using betadine in the OR for skin prep is how it has been done for many years. Though that does not mean it should not be changed, it has been thought of as being the best practice for the cleaning of the surgical site. When discussing the issue with current OR nurses, they are unaware of the exact reason why they use it, no one knew any studies that supports their current practice. This is just “how they have always done it” and they thought this is the best way.
c. When interviewing current OR employees, not many people had much to say as to “why” they currently use betadine for preparing the skin. As of right now, they have no seen enough evidence to change their technique. Currently the people involved are under the impression that this is the best way to prepare the skin for surgery. A3.
Darouiche, R. O., Wall, M. J. J., Otterson, M. F., Webb, A. L., Carrick, M. M., Miller, H. J., Awad, S. S., & Crosby, C. T. (2010). Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20054046 Edwards P, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003949. DOI: 10.1002/14651858.CD003949.pub2. Eiselt, D. (2009). Presurgical skin preparation with a novel 2% chlorhexidine gluconate cloth reduces rates of surgical site infection in orthopaedic surgical patients. Orthopaedic nursing, 28(3), 141-145. doi: 10.1097/NOR.0b013e3181a469db Jarral, O. A., McCormack, D. J., Ibrahim, S., & Shipolini, A. R. (2011). Should surgeons scrub with chlorhexidine or iodine prior to surgery?. Retrieved from http://icvts.oxfordjournals.org/content/12/6/1017.full.pdf html Noorani, A., Rabey, N., Walsh, S., & Davies, R. (2010). Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. (11 ed., Vol. 97, pp. 1614-20). Cambridge, UK: British Journal of Surgery Society Ltd. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20878942
When thinking about patient safety, it is easy to see that Chlorhexidine is much more effective against surgical site infections then betadine. Chlorhexidine–alcohol was significantly more protective than povidone–iodine against both superficial incisional infections and deep incisional infection ( Darouiche, Wall, Otterson, Webb, Carrick, Mikkler, Awad & Crosby, 2010). In return, especially since Obama-care has...