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Tuesday 16 May 2017
Mater has recently launched Skin preparation of the surgical patient guidelines.
Background: Surgical site infection (SSI) occurs in 2 to 5 per cent of patients undergoing inpatient surgery. Reducing the number of bacteria on the skin around the incision site reduces the risk of a patient developing a SSI. Skin antisepsis using an appropriate antimicrobial agent removes transient and resident bacteria through a combination of mechanical removal, chemical killing and inhibition.
Major recommendations: Chlorhexidine gluconate 2% and alcohol 70%—the recommendation is to use this antiseptic solution as first line for surgeries on intact skin.
There is good evidence that this combination is more effective than iodine (including povidone-iodine), with or without alcohol. It should not to be used on eyes, ears, genitalia, open wounds, neural tissue, mucous membranes or neonates where there are potential contraindications. The major safety concern is associated with flammability of the alcohol, the solution must therefore be allowed to dry completely before incision or diathermy.
Other recommended skin antiseptics, including uses and contraindications, are listed in the skin preparation guideline.
Other recommendations: Patients should shower before surgery. An antiseptic wash is recommended prior to theatre if an implantable device is to be inserted.
The operative site needs to be clean before performing skin preparation—gross soil, grease, skin oil, blood, etc., needs to be removed to ensure maximal efficacy of skin antisepsis.
Removal of hair—clippers are to be used. Shaving is to be avoided to prevent microtrauma and abrasions to the skin.
Careful application of skin prep solution to avoid pooling—particularly important consideration if an alcohol based solution is being used.
Skin preparation should be allowed to air dry prior to incision. A minimum of two minutes continuous contact time is required to ensure maximal efficacy. Manual drying reduces the efficacy of the skin preparation solution and is discouraged.
For full details, the guidelines are accessible via the Mater website.
For further information about skin preparation or any other infection prevention measures, please contact Director, Infectious Diseases, Dr Paul Griffin via [email protected].
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