applied the appropriate prep in only 3% of cases and followed dry times
only 41% of the time, they knew they not only had to educate staff. They
also had to limit the skin prep agents available at the institution.
They found that the facility had 9 different product options and
that, for povidone-iodine solutions, the scrub and paint directions
for use differed between 2 and 3 different manufacturers. As a
result, the researchers chose to reduce the number of prep solutions
available for use in an effort to limit the variability of appropriate
application techniques and dry times. Their efforts worked: Prep
time compliance for 2% CHG/70% isopropyl alcohol and aqueous
CHG solutions went from 6% to 50% and from 0% to 40%, respective-
ly. Dry time compliance for aqueous CHG and povidone-iodine solu-
tions jumped from 48% to 84% and from 14% to 78%, respectively.
Continued progress
You've identified prepping problem areas and implemented a process
improvement plan, so what's next? Post-intervention audits measure
the success of your efforts to improve prepping practices and identify
new and persistent challenges. It's also imperative that your staff
receive repeated education on prepping guidelines, technique demon-
stration and scientific rationale for best practices.
Ultimately, if you want to maintain the gains you achieve with an
intervention, continue to measure compliance. Adopting a shifting
schedule of random audits throughout the year or conducting a
regular audit review of your electronic medical records to verify
that preps were allowed to dry adequately before draping can help
those compliance percentages to keep moving in the right direc-
tion and continue the climb above 50%.
OSM
M A Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 5
Dr. Johnson (hboehm705@gmail.com) is a freelance medical writer based in
Vero Beach, Fla.
