How do you....

Re: How do you....

Emily Hibbs — Thu, 20 Aug 2009 20:04:02 GMT

We use Haemo-sol with cold water for instruments, leave to soak for 10 minutes then rinse under tap. It's amazing stuff for getting rid of blood!

Re: How do you....

Laura Ringsell — Thu, 20 Aug 2009 19:47:47 GMT

[quote user="Deemus"]

Instruments are scrubbed in washing up liquid

[/quote]

That's a new one on me - we soak in cold water - scrub and rinse under a running tap and then leave in a medizyme (20ml in 100ml) for 20 minutes. Feel a bit anxious about fairy or am I the only one!

Re: How do you....

Deemus — Tue, 18 Aug 2009 08:32:01 GMT

At our place, we scrub op sites with Hibiscrub diltued in water. We use cotton wool to scrub but it must be thoroughly squeezed before use. Start in the prep room and then into theatre for a final scrub and a squirt of spirit.

We use pevidine for eyes, ears and open wounds.

Instruments are scrubbed in washing up liquid, lubricated and then packed. We do have an ultrasound but the boss doesn't like the sound. (Yes, I know....)

We only have the fabric drapes, most of which have seen better days if I'm totally honest. The idea of dispasable drapes sent the boss into a tail spin so I've dropped the subject. The gowns are fabric and also sterilised.

Re: How do you....

Nick Shackleton — Fri, 14 Aug 2009 13:11:49 GMT

i would say that i think the diversity of replies is down to where people work, where they were taught and who they were taught. Like with most things in nursing there is more than one way of doing things! Don't believe there is one clear cut way of doing somethings (althou is some situations there is)

Re: How do you....

Laura Ringsell — Fri, 14 Aug 2009 09:43:09 GMT

[quote user="Nick Shackleton"]

Get a 5 litre botle
add 750ml Hibbitane
add 250mls water
add 4 litres surgical spirit
Use instead of normal spirit

[/quote]

You are the nurses answer to Jamie Oliver!!!

I appear to have opened a very lively debate on scrubbing and use of products - this is great, very informatie and useful - thanks everyone!

Re: How do you....

sisterscope1 — Thu, 13 Aug 2009 23:57:33 GMT

[quote user="Fluffy"]

3. Are you using fabric re-useable or water repellant disposable drapes?

[/quote]

Currently we use single use disposable gowns and drapes for all surgeries, along with polyware etc,. The cost of single use items has dropped considerably and is now within the grasp of most practices. However, there has been considerable interest in reposable draping/gowning systems w.r.t environmental concerns. There are now systems that address the requirements of barrier surgical fabrics with limited environmental impact. These, however, are sadly limited to commercial processes which are currently prohibited w.r.t zoonotic, "humanotic" disease transfer. Interestingly, despite many years of brainwashing, and I put my hand up for being a part of that, there is little conclusive evidence based research - apart from surrogate outcomes, to suggest that the use of single use, non-woven fabrics adds anything useful in reducing surgical site infections in all but the "cleanest" class of surgery, such as joint replacement.

Re: How do you....

sisterscope1 — Thu, 13 Aug 2009 23:40:44 GMT

http://hibihealth.com/res/hibiscrub-data-sheet.pdf

Re: How do you....

Fiona Leathers — Thu, 13 Aug 2009 23:31:37 GMT

If you read the back of the bottle of our hibiscrub it says use neat.

Re: How do you....

sisterscope1 — Thu, 13 Aug 2009 23:06:58 GMT

As for instruments...instruments are pre-cleaned in a MediZyme in an ultrasonic cleaner for 5 mins before passing through a washer-disinfector. Uses a ph11 detergent for main wash and RO water for final rinse, heated to 93edegC 5mins to achieve thermal disinfection.

Re: How do you....

sisterscope1 — Thu, 13 Aug 2009 23:04:45 GMT

I'm confused as to where the concept of using chlorhexidine gluconate in a detergent formulation neat has come from. The proprietary formulations of CHG in detergent are liscensed for pre operative hand antisepsis and preparation of surgical sites, no recommendations are given to dilutions etc. For hands, the scrub solution is used in combination with water and hence diluted. For a detergent to be effective, it needs to be combined wth water - one end of the molecule is hydrophillic (attracted to water) and one end hydrophobic (attracted to dirt, etc), hence the dirt is lifted and suspended from the area of contact. Therefore, for chlorhexidine gluconate to be effective in a detergent formulation, e.g Hibiscrub, it needs to be in combination with water. The minimal bactericidal concentration for CHG on almost all pathogenic organisms, admittedly in vitro, is 0.01%. A 4% solution in detergent can undergo considerable dilution without affecting its bactericidal properties. If a 50:50 dilution is used, this gives 2% CHG which is more than enough. Also, consider that skin preparation is a two stage process, the first being the removal of physical dirt and transient microbes, the second being reduction of resident flora to sub pathogenic levels - this is achieved rapidly and very successfully with an alcohol combined with an antiseptic agent, such as CHG. There is little point in excessively "scrubbing" a surgical site in order to achieve anything which may be considered sterile. In fact, more than 20% of resident flora remain inaccessible to surgical site antisepsis - these organisms are frequently implicated in the incidence of surgical site infections - an endogenous source. "Over prepping" surgical sites may lead to an increase incidence of SSI due to microlacerations and friction trauma of intact skin/mucous membranes where tissue fluid is leaked into the site and acts as a food source for inaccessible organisms and leads to a rebound population of resident flora. There are few conclusive studies to suggest an ideal skin prep routine, in fact some authors question sking prepping at all. Measuring surrogate outcomes, such as numbers of colony forming units, which is common when investigating surgical site infections, has not been proved to be a useful indicator of the primary outcome - incidnece surgical site infections.

Re: How do you....

loobylou — Thu, 13 Aug 2009 20:55:33 GMT

1- full scrub in prep using neat hibiscrub/ gauze swabs
final wipe in theatre once moved then spray of surgical spirit

2- soaked in trigene then rinsed off

3- mostly fabric drapes but soft tissue/ orthopaedic surgeon uses disposable

Re: How do you....

Nick Shackleton — Thu, 13 Aug 2009 20:04:52 GMT

[quote user="Freckle"]

[quote user="Nick Shackleton"]

we use lint free swabs for scrubbing everything. the only think we use cotton wool for is padding dressings or wrapping up lab samples!!!

[/quote]

can i come and work with you please

HATE having to use cotton wool for scrubbing up! if there are no partners about, i always break out the swabs lol!

[/quote]

We buy in swabs especially cos we have the xray swabs for in the surgical kits! We don't take on SVNs so maybe when your qualified who knows!

Re: How do you....

Freckle — Thu, 13 Aug 2009 20:00:56 GMT

[quote user="Nick Shackleton"]

we use lint free swabs for scrubbing everything. the only think we use cotton wool for is padding dressings or wrapping up lab samples!!!

[/quote]

can i come and work with you please

HATE having to use cotton wool for scrubbing up! if there are no partners about, i always break out the swabs lol!

Re: How do you....

Nick Shackleton — Thu, 13 Aug 2009 19:59:12 GMT

we use lint free swabs for scrubbing everything. the only think we use cotton wool for is padding dressings or wrapping up lab samples!!!

Re: How do you....

Freckle — Thu, 13 Aug 2009 19:55:06 GMT

oops - we use trigene for utensils etc too - let stuff soak for about 15 mins, then scrub and rinse

Re: How do you....

Freckle — Thu, 13 Aug 2009 19:54:14 GMT

i thought that hibiscrub was supposed to be used neat? we always do - squirt it directly onto opsite, and use damp cotton wool to scrub ( i prefer to use swabs, but get told off for it coz of pennies ) Always ensure contact time of about 5 mins too. Follow this with a spray of spirit to finish.

We use disposable waterproof drapes for 90% of stuff, but ortho vet insists on using cloth (sigh), so we have them kicking about too.

Re the instruments, ours get a medizyme bath, rinse and dry, with periodic lubrication.

Re: How do you....

Nick Shackleton — Thu, 13 Aug 2009 19:38:30 GMT

Get a 5 litre botle
add 750ml Hibbitane
add 250mls water
add 4 litres surgical spirit
Use instead of normal spirit

Re: How do you....

Laura Ringsell — Thu, 13 Aug 2009 19:25:41 GMT

1 - a 50/50 hibi mix in prep then again in theatre followed by a spray of Hibitane.

2. I use Trigene for utensils (have seen hibi and fairy liquid used - hence query)

3. Drapes - generally the disposable ones but do have fabric knocking around too :(

To answer the query re instrument cleaning. Instruments are rinsed in cold water, scrubbed and then left in a medizyme dilution bath for 20 mins, rinsed, dried , spray joints with silkospray and hey presto!

@Nick - what is the hibitane/spirit mixture you mention?

Re: How do you....

thebeestingbutterfly — Thu, 13 Aug 2009 12:49:04 GMT

1. surgical scrub in our place is usually a preliminary diluted hibi/ poviodene in prep, move through to theatre and do a thorough scrub whilst vet scrubs up and finished with a quick spray of spirit

2. we tend to use trigene for all our utensils, everything gets soaked for 15 minutes then rinsed thoroughly afterwards, we obvoiusly give them a quick rinse to get all the food etc off and we have washing up liquid too for more oil based foods.

3. as for drapes we use all of the above, routinely we have disposable cut yourself millpledge drapes, but we also ue the transparent baxter ones that come pre packed, cloth drapes are used but we try to avoid them!

What do you do in your place?

What kind of instrument clener do you use?

Re: How do you....

Nick Shackleton — Thu, 13 Aug 2009 12:46:50 GMT

1. General prep using hibiscrub and water (50% dilution) in prep room, followed by bicyle spoke technique then spray with hibitane/spirit mixutre, whip this off with dry swabs and then respray.

Once in theatre just bicycle spoke technique followed by hibitane/spirit mix in theatre.

2. ALL food bowls and litter trays cleaned in trigene then rinsed. Bowls and trays out of isolation are cleaned in Virkon followed by rinsing in warm water.

3. Disposable drapes throughout, no fabric drapes in the practice!