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!!

[cdsga]

If 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.

[nursinadream]

CDS, 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 lady partsl preps, though. We have read the product guidelines about not using it perineally.

Deb

[cdsga]

For lady partsl preps try Technicare.

There are not many alternatives other than betadine for lady partsl preps

you just aren't supposed to use the scrub only the solution.

We use Technicare for our iodine sensitive patients.

It's good for facial preps--it's not so good for ortho, but preps are like pesticides. some kill fleas, some don't.

And you're right about doctors not knowing much about preps.

We must help them to know.

:typing

[dcasjh811]

When doing a vag prep JCAHO/AORN state that you should prep clean to dirty but prevent any splashing to go onto a preped abdomen. So to prevent splashing we have always preped the lady parts first and then prep the abdomen. How many people are using hibiclens for the perineum prep? We have a new surgeon who wants to use hibiclens for the perineum and we also have a infection control nurse who would like us to use chloraprep on the perieum. ANY using chloraprep on the perineum? I don't like the idea very much.

[cdsga]

No our hospital does not condone or support the use of CHG for mucous membrane preps. Manufacturers' instructions state not to do this. We were using Technicare, but that is unavailable at this point. We recieved approval from INfection Prevention to use an alternative to Technicare--we use PCMX and have 1995 Mangram resource for that. It is the only option other than povidone iodine. Alot of research went into it.