Surgical Site Preparation!

RE: Surgical Site Preparation!

Rob Watkins — Thu, 01 Dec 2022 22:02:55 GMT

Hi Alice...

We don't hide behind a pseudonym... and are open and honest with our presentations and training.

You're more than welcome to contact me at rob@invictavet.com

We can provide you with the information we have on file.

It might be worth noting that ChloraPrep holds a full marketing authorisation as a licensed (human) medicine. Thus there is a full dossier to support any claims that are made.

Rob Watkins

Managing Director

Invicta Animal Health

RE: Surgical Site Preparation!

Alice Weaver — Wed, 23 Nov 2022 08:14:48 GMT

I’ve thought about this. I gave blood recently, having not done so for 10+ years, and the staff now prep your arm with a mini Chloraprep wand and use a timer to ensure correct contact time. It certainly made me think, because presumably it’s been through the NICE process and been approved.

I’m a little hesitant because any research Invicta present will likely be be biased, ie in a PICO question it would probably be asking about Chloraprep VS Chlorhex scrub and non sterile swabs. I don’t doubt that if you are using a single-use sterile applicator there will be fewer commensurate bacteria cultured afterwards. I’m not based in any one practice so don’t have any say in big changes in protocol ie using Chloraprep. It does niggle that the wands are single-use and there is quite a lot of waste. From what I have heard all their data are from human studies, but I guess the only way I would find out is to contact them!

As an aside, I haven’t seen any infection in any surgical site I’ve been involved with ever. I’m a Clinical Supervisor and I would like to make sure I’m discussing this sort of thing in a sensible EBVM-based manner. It’s something I think about a lot and there are certainly times where I feel like maybe I should just do my own study, as there just doesn’t seem to be enough research in this area! I wouldn’t know where to start though!

RE: Surgical Site Preparation!

apache — Tue, 22 Nov 2022 23:16:55 GMT

[quote userid="2109" url="~/001/veterinary-nurse-clinical/small-animal/surgical-nursing-theatre-practice/f/discussions/32365/surgical-site-preparation/177940#177940"]Contact Invicta (the guys behind Chloroprep) I believe they have done a lot of research into this. They can come to your practice and do lunch and learn and informative practical guidance. They can probably provide you with research data as well [/quote]

The 'evidence' they present is next to useless. Makes a mockery of EBVM whilst generating excessive plastic waste........

I think the best way to do anything with poor evidence is to audit your outcomes. IS what you are doing working? Are you getting many post-operative infections etc? There is little point changing anything if what you do is working.

A few of my thoughts, not necessarily EBVM, but we do audit and don't see post op infections.....

Hibi much better dilluted. As long as foaming then that's enough. It comes as a 4% solution we would dilute down 1 part hibi, 3 or 4 parts water. Cleans much better like this, foams. Undiluted is a sticky mess that won't clean properly (50:50 also similar).
I like Hibitane (or alcohol/chlorhex mix) for final spray.
Can buy wipes with hibi in water and alcohol solution with long shelf life, so no issue with making up in advance IMO
For a cat spay we would clip maybe 5X5cm square - unsure how you manage a concentric circle in that space.
There is evidence that sucking hair with a vacuum increases bacterial load in the air, so we stopped doing that 10+ years ago.

RE: Surgical Site Preparation!

Nick Shackleton — Tue, 22 Nov 2022 22:47:04 GMT

Contact Invicta (the guys behind Chloroprep) I believe they have done a lot of research into this. They can come to your practice and do lunch and learn and informative practical guidance. They can probably provide you with research data as well

RE: Surgical Site Preparation!

Julie-ann Machin — Tue, 22 Nov 2022 15:54:46 GMT

I think that it's definitely the case about licensing. Having looked through the WHO 2018 human guidelines though, it seems that the studies are not entirely certain for humans either

www.who.int/.../global-guidelines-for-the-prevention-of-surgical-site-infection-2nd-ed

RE: Surgical Site Preparation!

Alice Weaver — Tue, 22 Nov 2022 14:06:36 GMT

I had heard that hibi should be used neat as well. But this morning I read a study that said it is designed to be used with water to activate the hydrophilic and hydrophobic properties (ie lift away dirt), and also that dilution to 2-4% with a minimum contact time of 2 minutes is sufficient. I wonder if it's a case of the license is for the product to be used undiluted, and any dilution is backed by some evidence but off-license use? I just feel like there is so much wishy-washy evidence about this, and not enough good-quality studies!

RE: Surgical Site Preparation!

Julie-ann Machin — Tue, 22 Nov 2022 13:14:16 GMT

Hi, I was taught that chlorhexidine is designed to be used neat. Obviously this makes it sticky and difficult to remove the residue. The reason that you are cleaning first is to remove the dirt, and oils from the skin so it is fine to use a pH 5.5 soap with water for cleaning in the way you describe. The skin's defence is from oils so therefore drying out the skin when scrubbing with hibiscrub can actually create a route for infection. As long as you are finishing up with chlorhexidine spirit for the appropriate contact time (or another suitable product) then it shouldn't matter that you missed cleaning with the hibiscrub. I have sterile swab packs for final prep which I turn upside down so the plastic is at the bottom and then pour on chlorhexidine spirit and use clean gloves for final prep with these instead of spraying spirit.