skin prep - page 2
I am looking for some literature on the use of betadine skin prep, in the hospitals i've worked they use multi use bottles. Having done some research on this there is evidence to suggest these... Read More
Apr 2, '08Quote from Marie_LPNWe have recently started using the ChlorPrep too. We have gone back to DuraPrep when using Ioban sticky drapes because of the ChlorPrep not allowing it to stick for long. We also have switched from teal to an orange color ChlorPrep because there was problems with recovery nurses mistaking the blue tint left (even after cleaning) with cyanotic tissue.
We love that stuff too. We use to have the clear version, bit you could barely see where you had prepped at with it.
Unfortunately, when using ClorPrep, we've had issues with Ioban not sticking to the skin after the ChlorPrep is used.
Apr 5, '08We primarily use single use....I think the multi use bottles are more for huge prep areas (chin to ankles!)
I have heard we will be going to primarily Chloraprep - one of the reasons being is that (if it is not washed off) it provides 48 hrs of post op antimicrobial action. Not washing it off will be a "culture change" and I expect there will be some resistance to using it....but we'll see.
Apr 6, '08Our Betadine prep kits come with single use bottles but we also have Chloraprep. We use the Chloroprep most of the time but if it's an open fracture or any kind of an open wound, we use the Betadine. We were told you can't use Chloroprep over an open wound.
Apr 6, '08Quote from cicinurseWe normally use Betadine and ours do not come in single use bottles but we haven't had any problems at all. We use Technicare on perineal preps when patients are allergic to Povidone-Iodine. Our Infection Control department recommends Chloraprep but some services have been slow in compliance. The Ortho docs complained that it has produced rashes on their patients. I love Chloraprep---yes we use the orange tint now, complaints made on post op about the blue-green tint and looking cyanotic. Chloraprep cannot be used on Mucous membranes and on babies less than 2 months old.We are using Technicare for our Vaginal preps. Is anyone else using this product?
Apr 14, '08Quote from JennKolyWe have stopped using alcohol or alcohol based preps due to OR fires.
Sorry to hear that but it is really sad. I've only been in the OR for a year and a half now, and we use chloraprep and alcohol very frequently, but we haven't had any fires related to that. The only fires we've had were from a new circulator turning the light cord on for two different occasions and not letting their team know.
I love chloraprep and would be very saddened by it being removed from our use.
Aug 19, '08When you perform vaginal preps or any prep, for that matter, you have to follow standards and also the manufacturer's instructions. Hibiclens and alcohol preps are not to be used in the genital areas. There are very few options for vaginal preps beside betadine. If the patient is sensitive to iodine based products Technicare is the best option or just saline.
Our hospital took Technicare to our infection control committee and had it approved for use on these patients.
Legally, when you go outside of the manufacturer's guidelines or have no prescriptives for diluting agents, and the patient has an irritational response to the product you used, you run the risk of answering for the untoward reaction.
I also read the situations when you have combination abd, perineal preps and folks performing the vaginal prep first then the abdominal. While the standards say you should perform the dirty areas last. They don't really address the nature of this combo prep. It makes more sense to do the vaginal prep first, put in a foley if needed then do the abdominal prep to prevent splashing. You know that the preps can be messy and plenty of splashing can occur.
We need a consensus on this type of prep because we are doing more of these everyday.
Anybody have any thoughts?
Aug 19, '08CHg is the best agent (Hibiclens or Chloraprep)
There is no bacteria that is resistant to it after years and years of use.
Betadine and iodine based products break down when in contact with blood and other organics. Because of this you really have to look at the best agent for the case. To prevent surgical site infections, this becomes even more important. Anyone aware of SCIP?
Aug 21, '08You mentioned SCIP, just curious what are the SCIP guidelines on prepping? We have several SCIP guidelines we follow, but I haven't heard anything about prepping. We use Betadine solution and scrub single use bottles), as well as duraprep. If a pt is allergic to betadine we use hibaclinse or zepherin (sp?) solution. I had no idea that increasing the temp causes break down of the betadine solution. We have one tech that puts the bottle of betadine in her warm water to make it more comfortable for the patient :uhoh21:. Our heart surgeon uses Iodine tincture and he has zero sternal infections. The only chloraprep we use comes in the central line kits. Maybe I should do some looking into different preps....Then again I never really hear of many of our pt's getting incision site infections....probably will get the ol' "if it ain't broke don't fix it" run around...
Aug 21, '08Eyes, Middle ear, mucous membranes,skinAgentApplication/AmountKillTimeDurationEfficacy/OrganismTissueContraindicationsPotential/Skin ReactionsToxicity/ChemicalBurnsTransdermalPenetrationpHSpecialInfo.Alcohol(70% Isopropyl)N/AImmediateNoneGram (+)Gram(-)TB,various fungi, certainEnveloped virusesYes>30%Skin, eyes, Mucous MembranesNo6.8FlammableBetadine(10%Povidone Iodine)10 ml>2 minsVariable-Affected by pH, temp and exposure timeGram(+)Gram(-), fungi, spores, some virusesYes30%SkinYes4.0Effects neutralized on contact with organicsChloraprep(2% Chlorhexidene Gluconate+70%Isopropyl Alcohol)Prepared applicatorImmediate48 hoursGram(+)Gram(-), TB, various fungi, minimal virusesYes30%
(infants <2 months),Meninges
No(Binds with skin)5.5-7.0FlammableEffects pHdependent.Duraprep(0.7% Iodine+74% Isopropyl Alcohol)Prepared applicatorImmediate>24 hoursSame as betadineYes30%Skin, eyes, ears, mucous membranesYes4.0-5.0FlammableNot water soluableHibiclens(4% Chlorhexidene Glucaonate)10 ml>2 minscumulativeeffectsVariableSame as chloraprepYes30%Eyes, Middle Ear, Meninges, skin, Mucous MembranesNo(Binds with skin)5.86EffectspH dependent.Inactivatedin contact with saline.Phisohex(Hexachloophene)5-10 ml15-30 secsGram (+)LongerGram(-)>3 hoursGram(+)YesCumulativeEffectsNeuro toxicEyes, Ears, MeningesYes5.0-6.0Cumulative effects are exponentialTechnicare(3% Chloroxylenol)5-10 ml30 secs>24 hoursGram(+)Gram(-) TB Yeast FungiNo<10%NoneYes7.2Use for Mucous MembranesWeak Tea(Mild Tinc Iodine+70%Isopropyl Alcohol)N/AImmediateVariableSame as Betadineyes30%Skin, eyes, mucous membranesYes(From Iodine)5.0-7.0Mixed by hospital pharmacy.Flammable
this is a compilation of what we use it may help you
Aug 25, '08hi, in our hospital, we use three cherryballs w/ 7.5% betadine cleanser, then another 3 cherryballs w/ 90% alcohol & lastly 3 cherryballs w/ 10% betadine antiseptic for our skin prep...just want to ask you guys if it's still ideal... thanks....more power to us Nurses!!!
Aug 25, '08We use Merlin --one step prep(betadine solution). It is pretty good you can use it upside total knees and hips. We have gotten rid of all our Duraprep and Chloraprep, except in Central Line Kits. If someone is allergic to iodine we usually will use Techincare for our alternative. As with most preps it has it's good points and bad points.
Aug 26, '08If you use multi use bottles they need to be labeled with a date of 30 days after opening for the first time.
Betadine is not to be heated
It is an effective prep and very inexpensive, that's why it's still around.
There is a graph posted earlier--it did not come out like it was supposed to, but you can get the gist of the table of preps.
What nurses need to do now is try to suggest prep solutions that are best for the case you are preparing to do.
One prep is not best for all cases.
SCIP prep guidelines have to do with hair removal with clippers not razors
And the initiative is to decrease surgical site infections.
It is a complex issue and most OR nurses don't see the patients post operatively unless the patient returns for f/u procedures or infections.
But, others do see the patient and evaluate the patient 30 days post procedure.
The kicker is starting in October, if it is determined that a patient infection or complication was caused by hospital treatment, the hospital will not be reimbursed by Medicare(and you can be sure that private pay insurance companies will do the same) and the hospital will have to eat the cost of that follow up treatment.
So while we can be happy with low surgical site infections, the ones that do happen will be costly and will closely be investigated.
Learn all you can to provide your patient with the best care.
Ironically, we should be doing this all the time for every patient, but we certainly haven't. This is the wake-up call.
Aug 27, '08CDS, Thanks for the good information you have told us about preps. Good reminders. In my OR in Louisville, KY we are working hard to choose and use the best preps. We have found that most surgeons don't really have a preference. They just want to keep moving. Chloraprep is used by most of our specialities - ortho too. This is based on info that the staff has provided about CHG, the active ingredient, being by far the best antimicrobial in all studies. Surgeons don't seem all that educated on skin preps. When one of them started asking for CHG (Hibiclens) I thought, well good, this guy has read some research. Well, no that wasn't the case. He was tired of hearing his patients complain about the "orange stain" on their skin.
CDS, we are very aware of the upcoming re-imbursement issues for infections. Working hard on prevention.
We don't currently have a solution for the vaginal preps, though. We have read the product guidelines about not using it perineally.