internal audits are a proven way to identify where gaps in best prac-
tices are occurring. There are many competency tools available to
help guide observations of your team in prepping action, including
AORN's Competency Verification Tool for Skin Antisepsis
(osmag.net/VkY7jQ) or the Agency for Healthcare Research and
Quality's (AHRQ) Surgical Skin Preparation Audit Tool
(osmag.net/jHM3mS). Some tips for effective auditing include:
• Ensure the auditor is familiar with the manufacturer's instructions
for the specific prepping product being used.
• Use an auditor who is not assisting with the skin preparation, so
she can objectively document each measure.
• Perform audits randomly and across a variety of procedures to
achieve a more global assessment of compliance.
• Audit as many procedures as you can. The AHRQ tool recom-
mends auditing at least 10 procedures, although it points out that "the
more patients you review, the more likely you are to identify opportu-
nities to improve the adequacy of surgical skin preparation."
• Pay attention to proper prepping of specific body areas. For exam-
ple, before shoulder surgery, ensure the axilla, an area of higher
microbial colonization, is prepped last. In abdominal procedures,
ensure the umbilicus is prepped first in order to avoid splashing
debris from the umbilicus onto the prepped abdomen.
• Monitor these skin prep variables as well. Among the Association
of Surgical Technologists recommendations for proper documentation
are patient education and pre-operative instructions, assessment of
allergies, removal and handling of jewelry, method of hair removal if
applicable, prep parameters and time of prep (including dry time).
Don't hesitate to engage industry professionals to assist with evalu-
ating and improving compliance with best practices. These industry
reps are well versed in their products' directions for use and can pro-
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