What is better iodine or spirit?

Re: What is better iodine or spirit?

Laura Ringsell — Sat, 01 Sep 2012 07:54:09 GMT

As a complete aside I have just read an article about the move away from a traditional hand scrub to using a surgical rub? Unfortunately the article didn't mention any products, does anyone have any information about these ??

Re: What is better iodine or spirit?

Laura Ringsell — Sat, 01 Sep 2012 07:33:52 GMT

No, that's a new one on me too. A great post that has made very interesting reading so thanks guys it has got me thinking which is one of the things I love about this site. Now to go away and do more reading. PS- love your quote Steph , that's me....daily ![quote user="Steph Smith BSc(hons) RVN"]

[quote user="Harrie Phillips RVN AVN DipVN (Surgical) TAE"]The alcohol 'rinse' to remove the CHG or PI scrub, should always be followed by a paint of the solution afterwards.[/quote]

That's interesting, I've never seen this done in practice before (for chlorhexidine) - have any of you guys??

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Re: What is better iodine or spirit?

Steph Smith BSc(hons) RVN — Tue, 24 Jul 2012 23:44:41 GMT

..In general practice, anyone else..?

Re: What is better iodine or spirit?

Rob Watkins — Tue, 24 Jul 2012 12:48:12 GMT

Yes... in about 10,000 cases and counting " />

Re: What is better iodine or spirit?

Steph Smith BSc(hons) RVN — Sun, 22 Jul 2012 22:21:54 GMT

[quote user="Harrie Phillips RVN AVN DipVN (Surgical) TAE"]The alcohol 'rinse' to remove the CHG or PI scrub, should always be followed by a paint of the solution afterwards.[/quote]

That's interesting, I've never seen this done in practice before (for chlorhexidine) - have any of you guys??

Re: What is better iodine or spirit?

Harrie Phillips RVN AVN DipVN (Surgical) TAE — Fri, 20 Jul 2012 12:26:22 GMT

Omg, where did my paragraphs go? Silly iPad. My students would have to resubmit for that too..... Sorry!

Re: What is better iodine or spirit?

Harrie Phillips RVN AVN DipVN (Surgical) TAE — Fri, 20 Jul 2012 12:25:19 GMT

Hi Rob. Thanks for the link to the study, I'm off to download a full version now. It's not one I have read before. It is however, based on chlorhexidine with alcohol, which I stated above is better. I might just not have made myself clear. We teach a modified concentric pattern. It essentially is the back and forth action in L-ish shapes working from the centre out, until there is a significant visible reduction in gross contamination. You are quite correct when you say back and forth is more effective than concentric. I am so anal about it, we even teach a special way to hold the gauze! I'm sure it raises eyebrows when I teach it to nurse who have been in clinic for while. I still keep the inner to outer philosophy when teaching because in practice that is what the junior nurses are seeing the seniors do. And here it can be quite hard to change the senior nurses mind if they are not keen on CE or keep up with the latest. No requirements here on CE or updating of quals unless you want. I find leaving some semblance of what the senior nurses do in the protocols we teach means better student compliance. It's not as confronting for those senior nurse who resist change either, when the students have only 'slightly' modified the technique. Guess it all comes back to those myths and habits! Haven't worked out to help 'older' nurses (and vets) cope with accepting new protocols when what they have been doing for 20 years has never given them any problems. They don't take well to the statement 'the world was once flat...'. I should have clarified, paint solution for CHG prep that we teach does include alcohol. I figured that was a given, my bad. Dealing with students you would think I am out of the habit of presuming. However when I was still in practice, any time we did iodine preps we only ever used straight PI solution paint. Meths in the rinse before yes, but PI solution for the final paint. Does anyone do a PI alcohol mix for that? And what dilution, I would be very interested. Oh, if any of my students use a solution for any skin prep other than a freshly made one for that patient, they fail. Well they are made to resubmit explaining what they should do and why;) Using single use skin prep (commercial bought) packets is rare in Australia in vet clinics, for surgical skin preps. Really only seen in some specialist centres, are they becoming more popular in the UK? It's hard enough to get GP clinics to use single use hand scrub packs (if they are using, they often reuse one for the entire day). Oh, I love a good discussion. Great for working out the brain cells and learning! Love hearing about trends over there as well. Not sure this discussion was what the original poster had in mind... Sorry for hijacking the post!

Re: What is better iodine or spirit?

Rob Watkins — Fri, 20 Jul 2012 11:44:46 GMT

Well said Harrie.

The problem is the practice of preoperative skin preparation in veterinary patients is built on myth, habit and rumours.

Just to clarify a couple of points:

"My understanding is that most studies seem to agree that CHG has greater residual action than PI, although I have seen no study that is really that conclusive."

Link to a 2010 landmark study directly comparing the two.

"and have good technique for the actual scrub process itself. Bad technique isn't overwritten by perfect dilutions of an antiseptic."

Interestingly the practice of "concentric prepping" or "spiral wipe" has no evidence to support it. Yet it is universally taught as best practice

In a study for the blood transfusion service in the UK it was found that a back and forth motion over the intended site achieved a more than double log reduction bacterial count opposed to a spiral wipe method.

"The alcohol 'rinse' to remove the CHG or PI scrub, should always be followed by a paint of the solution afterwards. So worrying about alcohol removing the scrub from the initial prep seems to be a mute point to me - if the paint is performed last."

Numerous studies have shown that an application of combined antiseptic is more desirable. I would be interested to see evidence that painting on a singular agent as a final step is advantageous especially as multi-patient use solutions are severely frowned upon in human hospitals.

Rob

Re: What is better iodine or spirit?

Harrie Phillips RVN AVN DipVN (Surgical) TAE — Fri, 20 Jul 2012 08:10:14 GMT

Hey Steph,

I don't know about iodine penetrating the sebum layer, so I won't pretend to be intelligent on that point. I do know that it really depends on which study you read as to which antiseptic is considered 'superior'.

My understanding is that most studies seem to agree that CHG has greater residual action than PI, although I have seen no study that is really that conclusive. They also seem to prefer CHG to PI as CHG is not inactivated by blood or serum proteins, whereas PI can be. In saying that PI has studies in it's favour too! If they were both exactly the same on the 'superior' scale, I would choose CHG for its lack of staining white dogs, but PI for scrubbing my hands, as I think it's gentler on my skin. Certainly doesn't dry them out like CHG can.

Yes, alcohol has no residual action, but that is why it's used in combination with either CHG or PI. Most studies agree that combining alcohol with the antiseptic is the best way to get the most antimicrobial action.

The alcohol 'rinse' to remove the CHG or PI scrub, should always be followed by a paint of the solution afterwards. So worrying about alcohol removing the scrub from the initial prep seems to be a mute point to me - if the paint is performed last.

We teach our baby nursies here that it doesn't matter which one you use, as long as you stick to either PI or CHG, not both, and have good technique for the actual scrub process itself. Bad technique isn't overwritten by perfect dilutions of an antiseptic.

I don't know about the UK, but here in Australia, bad technique or a combination of wrong solutions or dilutions seems to be very common in clinics. I'm desperate to do a multi layer study, looking at what is commonly used in clinics, at what dilution, and protocol, plus where they learnt the protocol they are using, how many people know about things like why we use alcohol, or CHG+PI is bad etc. Then take the most common protocols and test them in the lab. See if there really is a difference. I just dont have the time (or laboratory resources). This way I could establish what is used, an idea of education levels about it, and then test it all out.

We are never going to have the perfect combination or protocol, and there will always be studies to show one thing is better over the other, I just go with current research, and what the human hospitals are currently recommending (here in Aus CHG and alcohol is the flavour of the year) and then make it suit the vet clinic. I would just love to do my own study, more for personal curiosity than anything;)

Re: What is better iodine or spirit?

Steph Smith BSc(hons) RVN — Fri, 20 Jul 2012 02:52:42 GMT

I was also of the thinking that iodine and chlorhexidine are based on incompatible compounds and I never use them together.

It has been argued that applying spirit to dissolve hibi may remove the benefits of chlorhexidine's residual activity - and once evaporated, the spirit cannot provide any residual activity either. Using iodine-based products (correctly) may provide increased residual activity (of upto 1 hour) as the molecules in iodine can penetrate the sebum layer of the skin whereas chlorhexidine can not. Has anyone else heard this? As per biggish-name Pharma who produce chlorhexidine- and iodine-based skin preps. I just changed from hibi/spirit to iodine scrub/iodine+IMS

Re: What is better iodine or spirit?

Harrie Phillips RVN AVN DipVN (Surgical) TAE — Wed, 18 Jul 2012 02:54:35 GMT

Hibiscrub is chlorhexidine gluconate right? (sorry not familiar with the brandname) Chlorhexidine and iodine should never be used on the same patient, as there is evidence the chemical composition of each disinfectant cancels each other out, which means limited or no antiseptic properties.

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"Chlorhexidine and Povidone-iodine in combination are incompatible because of the cationic (positively charged ion) nature of Chlorhexidine and the anionic (negative charged ion) nature of Povidone, thus providing limited or no skin antisepsis." Journal of Small Animal Practice, 2009, Evans, L.K.M., Knowles, T.G., Werrett G, Holt, P.E.

Even if you are removing your hibiscrub as part of your overal skin prep procedure, you still shouldn't use Iodine as the final paint - chlorhexidine binds to keratin (giving us our residual action), so you are not going to remove it all and it will still interact with the iodine.

You can use alcohol with either chlorhex or iodine - in fact plenty of studies show this enhances their action. Plus you get the defatting of the skin, and bacterial kill that alcohol provides. Just don't use chlorhex and iodine together on the same patient.

Re: What is better iodine or spirit?

Rob Watkins — Tue, 17 Jul 2012 10:57:12 GMT

There is good evidence that antiseptics can become contaminated in veterinary environments as well

Linky

Re: What is better iodine or spirit?

Rob Watkins — Mon, 16 Jul 2012 11:25:13 GMT

The short answer is neither.

"Applying an antiseptic as a spray does no more than soak an area - no significant cleaning action occurs"

. Inwood S. Br J Nurs 2007; 16: 1390-4.

Indeed there a large amount of human data to show that using spray bottles (refilled or replaced) provides an ideal vector for cross-contamination between workers and patients.

If you take a look at my profile page you will find an example SOP of an evidence-based method to prep patients. Or PM me if you want to know more.

Regards

Rob