Surgical Site Prep
“Surgical site infection (SSI) complicates an estimated 5% of all clean contaminated operations performed annually in US hospitals and accounts for the most common nosocomial infection in surgical patient’s” (Hemani & Lepor, 2009, p. 190). Prior to draping and the incision being made in a surgical procedure the skin around the surgical site is prepped to help decrease the chance of a SSI after the surgery is completed. One of the most common sources for pathogens which contribute to SSI’s is often thought to be the surface of the skin. This makes skin preparation at the time of the procedure critical. Throughout different hospitals there are several different types of prep solutions that are used. In the surgical department in which I work there are three types of prep solutions used, (Chlorhexidine gluconate (CHG), Chlorhexidine–Alcohol, and Povidone–Iodine). In my research of recent evaluations in this area I have found that there are two key points of the surgical prep where a change in the practice or the product can result in higher productivity, decreased costs and improved safety for the patient. Basis for Practice
The basis for practice in the hospital that I work in is totally physician preference. Each surgeon decides what type of prep is to be used and it is placed on their preference card. There is no standard hospital policy as to which prep to use for different procedures. The only policy which is in place is that Chlorhexidine-Alcohol cannot be used for pelvic or vaginal preps on females. The 1999 CDC Guideline for Prevention of Surgical Site Infection states: “Use an appropriate antiseptic agent for skin preparation” (Manz, Gardner, & Millard, 2006, p. 87). It does not state anywhere in its recommendations that one surgical prep is preferred over another. Therefore it is left up to each individual surgeon to decide what is to be used if there is no hospital policy as in the case where I work. Rationale
The goal of any preoperative skin preparation is to reduce the occurrence of SSI in a safe, user-friendly, and cost-effective manner. (Hemani & Lepor, 2009). The Association of periOperative Registered Nurses (AORN) Recommended Practices for Skin Preparation of Patients state: “Reduce resident microbial counts to sub-pathogenic amounts by the use of antimicrobial preoperative skin prep to inhibit rapid rebound growth of microorganisms a persistent antimicrobial preoperative skin prep agent should be used” (Manz et al., 2006, p. 88). The primary goal of the surgical skin prep is to decrease the occurrence of SSI’s and to do this must be able to remove dirt, oil and reduce microbial count with as little irritation as possible. The selection of the prep solution should also be based on “compatibility with the items it comes in contact with, including gloves and draping materials, flammability, whether or not it is inactivated by organic material, how easily it can be removed from the skin surface, the area being prepped, procedure being performed, and the patient’s condition” (Parson, 2003, para. 5). To accomplish this there needs to be evidenced based guidelines in place at the hospital to assist the nurse and physician determine which pre-operative skin prep should be used. Explanation
As stated above the practice of surgical prep at the hospital where I work is physician preference. According to Dr. Joel Feldman, Chief of Surgery at St. Vincent Hospital in Indianapolis, IN where I work, the decision is left up to the specific surgeon because of the many different types of surgery done at the hospital which may require specific types of surgical preps.
Darouiche, R. O., Wall, M. J., Itani, K. M., Otterson, M. F., Webb, A. L., Carrick, M. M.,...Berger, D. H. (2010, January 7). Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. The New England Journal Of Medicine, 362(1)....