Skin Preparation

Prepare the skin with an appropriate antiseptic solution starting in the middle of the surgical site and going outward in concentric circles in aseptic fashion. Alcohol, Chlorhexidine, povidone-iodine (Betadine), or a combination may be used as an antiseptic cleansing agent (Mangram et al., 1999).

The U.S. Centers for Disease Control and Prevention (CDC) and Healthcare Infection Control Practices Advisory Committee (HICPAC) updated guidelines in 2002 on skin preparation related to reducing central line infections. The CDC issued additional guidelines for the prevention of surgical site infection in 1999. The U.K. National Institute for Health and Clinical Excellence-Surgical Site Infection guidelines from 2008 agreed with each of these groups as well. Skin aseptic preparation with chlorhexidine 2% plus 70% isopropyl alcohol was the best at preventing surgical site infections as it achieves greater reductions in skin microflora and has greater residual activity after a single application (Mangram et al., 1999).

Chlorhexidine gluconate is effective even in the presence of blood or serum proteins, whereas blood and serum proteins may inactivate povidone-iodine. However, conflicting data show that a combination of iodine povacrylex in iso-propyl alcohol may reduce infection rates greatest in general surgery patients (Swenson et al., 2009). Isopropyl alcohol 70% is effective immediately, but the antiseptic effect is not sustained. Combinations are superior to isopropyl alcohol or chlorhexidine alone (Adams et al., 2005; Hibbard, 2005).

Many surgical site infections are from endogenous staphy-lococcal skin flora. An increasing number are also resistant to antibiotics, such as methicillin-resistant Staphylococcus aureus (MRSA). No clear guidelines exist on how best to reduce MRSA infections, but good handwashing and aseptic technique are a part of the prevention of MRSA-related surgical site infections (Siegel et al., 2006).

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