The questions were valid and appropriate. "Be direct in explaining
the reasoning behind proper prepping practices — this is how it has
to be done if you want to get the proper log reduction of bacteria and
the highest, sustained kill rate on the patient's skin before making an
incision," says Ms. Hasnain. "Staff were more willing to buy in when
they realized there was an evidence-based rationale behind what we
wanted done."
In part, UTSW brought in prep manufacturers to audit and educate to
help convince staff to change their prepping ways. "We wanted them to
know our efforts were part of an unbiased quality improvement proj-
ect," says Dr. Trivedi. "Once surgical team members bought in, interest
in improving our prepping practices began to build. And once interest
7 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 9
CHG/Alcohol
Aqueous CHG
(2% to 4%)
Iodine/Alcohol
5% to 10%
Povidone-Iodine
Mechanism
of action
Disrupts cell
membrane and
denatures proteins
Disrupts cell
membranes
Oxidation plus
substitution by free
iodine; denatures
proteins
Oxidation plus
substitution by
free iodine
Onset of activity
Rapid Intermediate Rapid Intermediate
Residual activity
48+ hours 4 to 12 hours 12 to 48 hours 2 to 3 hours
Application time
30 seconds on
dry skin; 2 minutes
on moist skin
4 minutes
(2-minute scrub,
blot, repeat)
Depends on site of
treatment area
5 minutes
Dry time
3 minutes on hair-
less skin; up to
1 hour in hair
Blot
3 minutes on hair-
less skin; up to
1 hour in hair
3 minutes
Part of your prepping improvement efforts should involve making
sure staff understand how preps work, how they should be
applied, how long they take to dry and how quickly they work to
reduce bacterial counts on the patients' skin. — Daniel Cook
SOURCE: University of Texas Southwestern Medical Center
Skin Prep Breakdown
CHART REVIEW
