Surgical Site Prep
Surgical Site Prep
Gaston Herndon
WGU
Surgical Site Prep
Procedure
“Surgical site infection (SSI) complicates an estimated 5% of all clean contaminated operations performed annually in US hospitals and accounts for the most common nosocomial infection in surgical patient’s” (Hemani & Lepor, 2009, p. 190). Prior to draping and the incision being made in a surgical procedure the skin around the surgical site is prepped to help decrease the chance of a SSI after the surgery is completed. One of the most common sources for pathogens which contribute to SSI’s is often thought to be the surface of the skin. This makes skin preparation at the time of the procedure critical. Throughout different hospitals there are several different types of prep solutions that are used. In the surgical department in which I work there are three types of prep solutions used, (Chlorhexidine gluconate (CHG), Chlorhexidine–Alcohol, and Povidone–Iodine). In my research of recent evaluations in this area I have found that there are two key points of the surgical prep where a change in the practice or the product can result in higher productivity, decreased costs and improved safety for the patient.
Basis for Practice The basis for practice in the hospital that I work in is totally physician preference. Each surgeon decides what type of prep is to be used and it is placed on their preference card. There is no standard hospital policy as to which prep to use for different procedures. The only policy which is in place is that Chlorhexidine-Alcohol cannot be used for pelvic or vaginal preps on females. The 1999 CDC Guideline for Prevention of Surgical Site Infection states: “Use an appropriate antiseptic agent for skin preparation” (Manz, Gardner, & Millard, 2006, p. 87). It does not state anywhere in its recommendations that one surgical prep is preferred over another. Therefore it is left up to each individual surgeon to decide what is to be used if there is no hospital
Gaston Herndon
WGU
Surgical Site Prep
Procedure
“Surgical site infection (SSI) complicates an estimated 5% of all clean contaminated operations performed annually in US hospitals and accounts for the most common nosocomial infection in surgical patient’s” (Hemani & Lepor, 2009, p. 190). Prior to draping and the incision being made in a surgical procedure the skin around the surgical site is prepped to help decrease the chance of a SSI after the surgery is completed. One of the most common sources for pathogens which contribute to SSI’s is often thought to be the surface of the skin. This makes skin preparation at the time of the procedure critical. Throughout different hospitals there are several different types of prep solutions that are used. In the surgical department in which I work there are three types of prep solutions used, (Chlorhexidine gluconate (CHG), Chlorhexidine–Alcohol, and Povidone–Iodine). In my research of recent evaluations in this area I have found that there are two key points of the surgical prep where a change in the practice or the product can result in higher productivity, decreased costs and improved safety for the patient.
Basis for Practice The basis for practice in the hospital that I work in is totally physician preference. Each surgeon decides what type of prep is to be used and it is placed on their preference card. There is no standard hospital policy as to which prep to use for different procedures. The only policy which is in place is that Chlorhexidine-Alcohol cannot be used for pelvic or vaginal preps on females. The 1999 CDC Guideline for Prevention of Surgical Site Infection states: “Use an appropriate antiseptic agent for skin preparation” (Manz, Gardner, & Millard, 2006, p. 87). It does not state anywhere in its recommendations that one surgical prep is preferred over another. Therefore it is left up to each individual surgeon to decide what is to be used if there is no hospital
References: Darouiche, R. O., Wall, M. J., Itani, K. M., Otterson, M. F., Webb, A. L., Carrick, M. M.,...Berger, D. H. (2010, January 7). Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. The New England Journal Of Medicine, 362(1). doi:10.1056/NEJMoa0810988 Hemani, M. L., & Lepor, H. (2009). Skin Preparation for the Prevention of Surgical Site Infection: Which Agent Is Best? Reviews in Urology, 11(4), 190-195. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809986/ Manz, E. A., Gardner, D., & Millard, M. (2006, August). Clipping, Prepping and Drapingfor Surgical Procedures. MANAGING INFECTION CONTROL, 84-97. Retrieved from http://www.csao.net/files/pdfs/70-2009-7475-9-Clip,Prep,Drape806.pdf Parson, R. (2003, September 1). Surgical Prep: The Right Product for the Right FunctionMinor changes bring major improvements in efficiency, safety and costs. Infection Control Today . Retrieved from http://www.infectioncontroltoday.com/articles/2003/09/infection-control-today-09-2003-surgical-prep.aspx The Association of periOperative Registered Nurses. (2002, January 1). Recommended practices for skin preparation of patients. AORN Journal. Retrieved from http://findarticles.com/p/articles/mi_m0FSL/is_1_75/ai_83664586/?tag=content;col1