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Subject: Skin Preparation Recommendations
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Alcohol is readily available, inexpensive, and the most rapid-acting skin antiseptic. It does not have any increased risk for the pregnant patient but must be allowed to dry completely to achieve a bacteriocidal effect. Drying also prevents any risk for ignition with use of electrocautery or lasers. Disadvantages include potential for spores to be resistant and potential for flammable reactions.
Iodophors (Betadine, others) provide broad-spectrum coverage, are associated with lack of microbial resistance, and provide a bacteriostatic effect as long as they exist on the skin. They are effective against methicillin-resistant S aureus (MRSA) and Enterococcus species. Significant resistance to povidone-iodine has not been documented. They were formulated to be less irritating and allergenic than pure iodine solutions but are also less active. They require at least 2 minutes of contact to release free iodine, which exerts the antibacterial activity. Povidone-iodine absorption through mucous membranes has been linked to fetal hypothyroidism, although there are reports of contact dermatitis. They may also impair wound healing.
Chlorhexidine gluconate (Hibaclens, others) offers broad-spectrum coverage against bacteria, yeast, and molds. It appears to provide greater reduction in skin microflora than povidone-iodine and remains active for hours after application. It does not have any increased risk for the pregnant patient. It should be used with caution around the eyes because of a risk for conjunctival irritation, keratitis, or corneal ulceration. It can cause ototoxicity if the patient has a perforated tympanic membrane.
Remove gross contamination from the skin, including soil, debris, or devitalized tissue.
Apply the skin-cleansing agent in concentric circles, starting from the intended surgical site.
Extend the area of skin cleansing to a wide enough area to cover the proposed operation, allowing for extension of the surgical field for the creation of additional incisions or drains.
Do not rub or scrub the skin during application of the antiseptic agent. Damaging the skin during application can lead to increased surgical site infections.