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S U R G I C A L
S K I N
A N T I S E P S I S
examine the literature for best practices (as you know, most surgeons base their
clinical decisions on peer-reviewed research). Our team found that chlorhexidine gluconate (CHG) combined with alcohol appears to be most effective for
skin asepsis, followed by povidone-iodine and alcohol in cases where CHG is
inappropriate (such as around open wounds, the eyes or mouth).
During one of your regular education sessions attended by nurses, surgeons
and anesthesia providers, present the findings of your literature review and
identify which prepping products will be used moving forward. Focus on the
evidence that supports the agents that are most effective for the procedures you
host, notify the surgical team that surgeon preference cards will be adjusted and
remove all non-approved products from the ORs and supply inventory.
Share the same information at a follow-up operative staff meeting, and post a
summary of the findings on a prominent bulletin board (or e-mail a copy to the
staff). Stress to your nurses that the infection control department (or your
infection preventionist) backs the change to the prepping regimen, and that the
surgeons have agreed on the standardized products.
Standardized prepping practices will empower nurses, who won't be afraid to
suggest the appropriate product when it's called for. They'll remind surgeons in
the ORs, "Hey, CHG would be best for this patient, based on the literature and
the procedure. We're going to use that, OK?" If another one of your preps is
more appropriate, they can suggest its use. This soft-sell approach won't be confrontational if everyone is on board with the effort to standardize your preps.
2. Reinforce compliance
CHG/alcohol single-use products became our first product choice (due to their
long-lasting properties), iodine/alcohol single-use second, and traditional povidone-iodine paint-and-scrub third. When all the non-compliant products were
removed, there wasn't much complaining, likely because the surgeons had
helped initiate the change — it's really key that they be involved from the beginning on any process improvement project.
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M O N T H 2014