skin prep

[matakamoo]

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 bottles could become contaminated. My question is do any hospitals use single patient use skin prep if so is there evidence in your hospital to back up this practice, any advice will be greatly appreciated.....thanks!!

[Likes2Dive]

Has any used or know where to get an ALCOHOL FREE one step prep. 3M used to make one (since discontinued) and they were perfect for when we could have alcohol.

[ewattsjt]

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.

We 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.

[justjenny]

We 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.

Jenny

[GadgetRN71, ASN, RN]

Our 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.

[MsLeylaBar]

We are using Technicare for our lady partsl preps. Is anyone else using this product?

We 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.

[heather2084, BSN]

We 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.

[cdsga]

When you perform lady partsl 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 lady partsl 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 lady partsl 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 lady partsl 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?

[cdsga]

CHg 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?

[Rae83]

You 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...

[cdsga]

Agent

Application/

Amount

Kill

Time

Duration

Efficacy/

Organism

Tissue

Contraindications

Potential/

Skin Reactions

Toxicity/

Chemical

Burns

Transdermal

Penetration

pH

Special

Info.

Alcohol

(70% Isopropyl)

N/A

Immediate

None

Gram (+)

Gram(-)

TB,various fungi, certain

Enveloped viruses

Yes

>30%

Skin, eyes, Mucous Membranes

No

6.8

Flammable

Betadine

(10%Povidone Iodine)

10 ml

>2 mins

Variable-

Affected by pH, temp and exposure time

Gram(+)

Gram(-), fungi, spores, some viruses

Yes

30%

Skin

Yes

4.0

Effects neutralized on contact with organics

Chloraprep

(2% Chlorhexidene Gluconate+70%Isopropyl Alcohol)

Prepared applicator

Immediate

48 hours

Gram(+)

Gram(-), TB, various fungi, minimal viruses

Yes

30%

Eyes, Middle ear, mucous membranes,skin

(infants

No

(Binds with skin)

5.5-7.0

Flammable

Effects pH

dependent.

Duraprep

(0.7% Iodine+74% Isopropyl Alcohol)

Prepared applicator

Immediate

>24 hours

Same as betadine

Yes

30%

Skin, eyes, ears, mucous membranes

Yes

4.0-5.0

Flammable

Not water soluable

Hibiclens

(4% Chlorhexidene Glucaonate)

10 ml

>2 mins

cumulative

effects

Variable

Same as chloraprep

Yes

30%

Eyes, Middle Ear, Meninges, skin, Mucous Membranes

No

(Binds with skin)

5.86

EffectspH dependent.

Inactivated

in contact with saline.

Phisohex

(Hexachloophene)

5-10 ml

15-30 secs

Gram (+)

Longer

Gram(-)

>3 hours

Gram(+)

Yes

Cumulative

Effects

Neuro toxic

Eyes, Ears, Meninges

Yes

5.0-6.0

Cumulative effects are exponential

Technicare

(3% Chloroxylenol)

5-10 ml

30 secs

>24 hours

Gram(+)

Gram(-) TB Yeast Fungi

No

None

Yes

7.2

Use for Mucous Membranes

Weak Tea

(Mild Tinc Iodine+70%

Isopropyl Alcohol)

N/A

Immediate

Variable

Same as Betadine

yes

30%

Skin, eyes, mucous membranes

Yes

(From Iodine)

5.0-7.0

Mixed by hospital pharmacy.

Flammable

this is a compilation of what we use it may help you

[starbok]

hi, 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!!!

[SouthmeetsEast]

We 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.