Prep

Hi there. Where I work, the patient arrives in the OR having rec'd a pre-op scrub with a hibitane scrub brush. In the OR, the patient in prepped with betadine in the usual fashion, wiped, then prepped with alcohol, and wiped again, the skin is then wrapped with a huge tegaderm. The only time we do any scrub in the OR, is for one of the older surgeons, for almost all internal fixations, and also external fixations, it does not matter if it is or is not an open fracture. By the way, we have no problem with infection in our total joints.........I also used to work on the surgical floor, and can assure of this. A ten minute scrub is really flippin' long!!

We don't do total joints where I work but we use betadine gel almost exclusively in our preps and don't have any problems. contact time is most important, so it's good to be fast with the gel. I've never heard of a timed prep, but i have only been in the o.r. for about a year. Also you may suggest trying duraprep or some other type of iodophor. they dry quick and have really excellent results. good luck!

Depends on the surgeon. Some like a 10 minute betadine scrub, betadine paint, then alcohol. Others prefer a 10 minute hibiclens, then alcohol, then Duraprep.

Whatever the prep, 10 minutes seems to be the norm for totals.

We don't use any betadine gel. I wonder how effective the gel is since there is no physical friction involved with the prep.

Other preps for general or gyn usually include a 3-5 minute betadine scrub and paint.

And I agree.....10 minutes is a LONG time to scrub!! My arms get a little tired by the end. However, it's the patient that benefits in the long run.

In our hospital it is policy for all patients receiving any implants in the OR , to have a pre-op scrub with Hibidil in daycare. We then do a short scrub in the OR after which we use the prep of choice for the particular surgeon.

Marijke

Thermacare.

We are using ChloraPrep (2% Chlorhexidine and 70% alcohol) which is basically a paint type prep for everything that doesn't involve mucosal membranes (still using betadine and hibiclens on gyn and butt cases). Pretty quick IMO.

Its implementation has been interesting since it is a "180" from all our old prep rules!

The only 10 minute bscrub/bsol prep I am doing is on penile implants and that 10 minutes feel like an hour, lol.

Currently, at our hospital, total joints get Duraprep. That's a prepackaged, betadine, alcohol mixture.

Our doc then covers the exposed skin with an Ioban drape.

On open wounds, you can't use Duraprep, so I go back to diluted Betadine Scub, followed by Betadine Solution.

Most of our general surgical cases also use Duraprep.

The GYN and URO docs use Hibiclens.

Our eye surgeons use either Betadine Solution or Scub.

Pre op, our pt's, for the most, are instructed to pre op shower with Hibiclens

Mike

I didnt realize some hospitals have standards for the prep for a particular type of surgery. Here it is all based on surgeon preference. Some of our Docs like betadine/betadine, some like an alcohol pre prep followed by chloraprep, while others prefer hibiclense/alcohol. all preps other than chloraprep are 10 minute preps for ortho cases, however.

What do you use when your patient has an iodine allergy? Also: Berry & Kohn has excellent hx. on the prep technique including timed preps/mechanics & chemical effectiveness.

for totals and any implant case, we used duraprep until about a month ago when we switched to chloraprep. we have found that ioban (which most our ortho docs use on implant cases) does not stick well to the chloraprep, so we are switching back to duraprep for cases with implants.

We've also made the switch to Chlora-prep, with the exception of open wounds, vag or urology type procedures...

And of course, we have the few docs who refuse to deviate from the good ol' betadine scrub & paint, & a few who only use Duraprep.

We are using Chloraprep as well. Interestingly, since switching from DuraPrep, we have had only one infection in i believe 9 months. It was right after we made the switch. Also, our infection control manager mandated the switch which didnt sit well with some of the docs. Alot of the ortho docs were set on using Duraprep and the ioban, but when Robin-icp- provided the evidence that the impregnated drapes had no effect on infection and the chloroprep was more effective than duraprep they accepted the change.

the new AORN guidelines have a nice table on preps as well.

-T