Outpatient Surgery Magazine

Manager's Guide to Patient Skin Preparation - February 2014

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 24 I N F E C T I O N P R E V E N T I O N 6. Povidone-iodine- and triclocarban-medicated soaps are just as effective as CHG in reducing skin microbial colony counts through pre-op showers. 7. A pre-op antiseptic shower can decrease microbial colony counts on a patient's skin for up to three days after surgery. 8. Reducing skin microbial counts has been definitively linked to a lower incidence of SSIs. Evidence and efficacy There's no lack of evidence that pre-op antiseptic showers reduce microbial colony counts on patients' skin.1-5 While some studies suggest that such reductions might help prevent post-op surgical site infections,1, 4, 11, 12 antiseptic showering has not been conclusively proven to lower infection rates.1, 3, 5-7 While one review of the available evidence argues that "[e]fforts to reduce the incidence of nosocomial surgical site infection should focus on interventions where effect has been demonstrated,"7 infection prevention authorities stand by the practice of pre-op showers. The Centers for Disease Control and Prevention's Guideline for Prevention of Surgical Site Infection advises patients "to shower or bathe with an antiseptic agent on at least the night before the operative day," even as it acknowledges that the scientific evidence the recommendation is based on is not quite as strong as that which informs its highest-rated recommendations.5 The Association of periOperative Registered Nurses expanded its standards in 2008 to suggest showering twice, since multiple applications of CHG can strengthen its effects. "Patients undergoing open Class I surgical procedures below the chin should have two pre-operative showers with [CHG] before surgery, when appropriate," states AORN.13 Plus, the practice makes logical sense. "The operative site needs to be clean," says Linda R. Greene, RN, MPS, CIC, manager of infection prevention at Highland Hospital in Rochester, N.Y. "Bathing with an antiseptic agent is probably helpful. Observa-tional evidence isn't the highest quality evidence, but what's

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