pre-op scrub

Re: pre-op scrub

Rob Watkins — Mon, 31 Mar 2014 11:26:52 GMT

Hi Laura

With regards to antiseptic solutions the best references are:

Ostrander 2005

Hibbard 2005

Adams 2005

Although there are a lot more.

In terms of application methods. Check out the newly published OSCE TP05 where the recommneded application method is back and forth.

Examiners will no longer accept concentric or bicycle spoke prepping methods.

This is something we have been teaching for over two and a half years. If anyone wants further information just PM me.

Rob

Re: pre-op scrub

Laura Moss — Fri, 28 Mar 2014 20:50:42 GMT

Hey do you have any references/research about using this skin prep method especially the dilution of solution of the final chlorehex prep?

Thanks

Re: pre-op scrub

Rob Watkins — Fri, 21 Mar 2014 09:36:24 GMT

You are absolutely right to say that habits/myths prevail over evidence when it comes to preoperative patient skin preparation.

But to be honest, the teaching of this topic has not been evidence based.

In terms of references for your work... Claires article (hyperlinked in my earlier post) summarises it well.

Other points to consider: (again hyperlinked to the reference)

The type and concentration of antiseptic to use. This paper provides a comparison.

The application method used is of equal importance. Concentric or bicycle spoke is not evidenced and when compared to friction, performs poorly. Referenced in this paper... the blood transfusion service compared 1409 patients prepped with a spiral wipe and 1409 patients prepped with a back and forth motion. The back and forth motion gave a 57% greater reduction in the bacterial count on the skin.

And to demonstrate that things could be improved:

A study in 2009 surveyed nurses to ask for dilution rate/contact time of antiseptic agents - overall 79% of you were unaware.

And before everyone cries that there is nothing wrong with what they currently do...

Take a look at vetaudit.co.uk which is a comprehensive audit of just shy of 19000 procedures... showing 7.1% required intervention post surgery.

I supply applicators for surgical prep and we offer training and support materials for this. If you take a look at my profile page you will find an example evidence-based Standard Operating Procedure.

This is just a small sample of the papers available so send me a PM if you would like more for your assignment.

Re: pre-op scrub

kkatkatk — Thu, 20 Mar 2014 21:54:31 GMT

thats interesting, i am interested in scrub techniques, it seems to me that what is done in practice is sometimes habit rather than evidence based, im doing an assignment which includes skin scrub at the moment. please can you let me know where you read about this ?study? so i can include this in my work.

thank in advance!

Re: pre-op scrub

Rob Watkins — Wed, 19 Mar 2014 09:14:53 GMT

I also should have added...

There is little, if any, evidence to show that spraying a patient with a solution actually achieves anything in terms of reducing bacterial count on the skin. Application with friction in a back and forth motion (not concentric or bicycle spoke) has been demonstrated to be the optimum application method.

Re: pre-op scrub

Rob Watkins — Tue, 18 Mar 2014 12:58:33 GMT

The solution should be freshly prepared for each patient without using multi-use bottles (such as trigger sprays).

Re: pre-op scrub

Michelle Baldwin — Tue, 18 Mar 2014 11:06:39 GMT

Hi, just read your post above. It is similar to our procedure. Can I ask how often you change the hibitable/water/surg spirit spray? Many thanks !

Re: pre-op scrub

arcticfox — Mon, 19 Aug 2013 17:00:11 GMT

Lather is important.

the Soap in the hibiscrub or povidone causes a lather when scrubbing, this acts as a surfactant and the lather changes the surface tension of the water to allow dirt, oil etc to be lifted off the skin. This makes it easier to get it clean.

Re: pre-op scrub

Craig McDonald — Sun, 18 Aug 2013 21:47:12 GMT

We have just changed to Nick's spray (hibitane, water, spirit mix) from just using spirit and everyone is happy with it so far.

Re: pre-op scrub

Sal the 1st — Sun, 27 Feb 2011 19:15:30 GMT

must be at least 4 years since I last used it - thankfully. was a good idea in principle but a disaster with light coloured animals. I remember a siamese spay being done midline so it didnt grow back a dark patch on its flank and the owner coming back for sutures out and saying a dark patch would have looked better than a blue patch all over its belly

Re: pre-op scrub

Katie Murphy RVN — Sun, 27 Feb 2011 19:09:49 GMT

Lol - I remember very blue westies coming back in after spaying.... do they still make it?

Re: pre-op scrub

Sal the 1st — Sun, 27 Feb 2011 19:03:06 GMT

I hate vetasept blue! clients arent keen on it either- a locum vet at a practice I was working it said it reminded him of the dye they pour on condemned meat!

Re: pre-op scrub

Katie Murphy RVN — Sun, 27 Feb 2011 18:53:55 GMT

What we do is similar to most of the above - but we do have carbol fuschin added to our final prep spray to make it easier to see that the whole area has been prepped. This makes it a darker pink but it doesn;t stain the animal post surgery like Vetasept blue.

Re: pre-op scrub

Juliet Drummond DAVN (med) RVN D32/33 — Sat, 26 Feb 2011 03:25:55 GMT

incidently, i use dilute hibitane rather than hibiscrub for open wounds, the detergent in hibiscrub can affect healing.

i use pevidine antiseptic solution to final prep eye ops, i don't know what everyone else uses to clean arounds eyes prior to final prep, but johnsons baby shampoo (diluted) is great. no more tears.

Re: pre-op scrub

Juliet Drummond DAVN (med) RVN D32/33 — Sat, 26 Feb 2011 03:22:38 GMT

it is also important not to over scrub the site.

i used to use the made up hibitane mix (per nick), but with clear industrial metholated spirit, not surgical spirit, as this made it go cloudy, and distilled / purified water.

i now use vetasept chlorhex spray, saves faffing about making up solution, the site is prepped using non woven swabs and 50:50 chlohex scrub / distilled water, until the swabs come away clean then the area is sprayed, and once dry draping can comence.

Re: pre-op scrub

Anonymous — Fri, 25 Feb 2011 19:37:43 GMT

Ditto Tracy - I heard that too

Re: pre-op scrub

Lisa White — Tue, 01 Feb 2011 22:01:53 GMT

Yes, we use spray bottles for the surgical spirit and the hibitane, water and spirit coctail. I'd definitely recommend them over wash bottles for this.

Re: pre-op scrub

Nick Shackleton — Tue, 01 Feb 2011 20:51:56 GMT

yeah we use spray bottles and BTW is hibitane ie non-foaming cholorohex.

Re: pre-op scrub

Gillian Davidson — Tue, 01 Feb 2011 20:19:44 GMT

When using the "pink spirit" mix i.e. chlorhex, H20, spirit mix , we use a wash bottle. This soaks the patient, not ideal. Does anyone use spray bottles for this?

Re: pre-op scrub

Anne Whipple RVN — Tue, 01 Feb 2011 17:00:00 GMT

I didn't think the actual lather bit was important, but rather the mechanical action of scrubbing (which results in lather) plus using the correct contact time in order to ensure you're getting proper levels of asepsis. That might be where 'lather is important' comes from as it's an indication you've been scrubbing for a while if you're not timing it.

Re: pre-op scrub

Tracy Windler RVN — Sun, 30 Jan 2011 13:56:35 GMT

I was told once by a cosmetic dermatologist that the "lather" aspect is only for our own benefit, as we perceive it to be cleaner if there are suds. Think about when you wash your hair, it feels like you havn't really washed it if it has't got all foamy! But, I don't know how true this is, or how reliabe the source is!

Re: pre-op scrub

salliee5 — Sat, 29 Jan 2011 20:28:32 GMT

DAFT QUESTION!

But as mentioned above, I was also taught that it was important to get 'a lather' when using Hibi, but why? I appreciate that the contact time is important but a lather?? Is this some chemical reaction thingy that I just practice but don't 'actually' understand!

Maybe a lather just indicates that actual scrubbing has taken place?

Anyhow just a randm curious question that has just popped into my head!!

Re: pre-op scrub

Phrin Vernon RVN — Fri, 28 Jan 2011 19:55:42 GMT

PS - must admit we do full scrub in prep then move to theatre in all but ortho cases - I realise this isn't ideal, and would adv that the lint free swab part onwards (from my regieme) is done in theatre - the cotton wool part, for me, is just for gross decontamination.

Not all the nurses at work do this - some just do weak diluted hibi then spirit with no ill effects.....

Re: pre-op scrub

Phrin Vernon RVN — Fri, 28 Jan 2011 19:51:54 GMT

There was a thread on here a while back about this.

I have been taught clip, hoover or roller away hairs, degrease (ie spirit), then chlorhex scrub, with damp cotton wool swabs with a squirt of hibi on - still gets up a lather which is the important thing.

Then swap to lint free swabs, damp with a squirt of hibi, outwards circles, then bicycle spokes, then spirit, and then a chlorhex/spirit mix - like Nick's recipe above!

Re: pre-op scrub

supamog — Fri, 28 Jan 2011 17:37:27 GMT

Thank you so much. exactly what i was looking for! much appreciated