Surgical site skin preparation

[Anonymous]

Dear Brains Trust

I have recently been asked by some of our surgeons if it is acceptable to use both alcohol based CHG and povidone-iodine solutions for surgical site skin prep; i.e. use alcoholic povidone-iodine first, allow to dry and then repeat with 2% CHG in 70% alcohol. I have always been of the understanding that this should not occur due the antiseptic effects of CHG and PVP-I being neutralised by each other, but cant seem to find enough evidence to support this. Would anyone be able to assist?

Many thanks
Mary

Mary Willimann CICP-E| Manager Infection Control
St John of God Subiaco Hospital
T: (08) 9382 6871 | M: 0439993772 | F: (08) 9382 6785 | E: Mary.Willimann@sjog.org.au
12 Salvado Road Subiaco WA 6008 | PO Box 14, Subiaco WA 6904
http://www.sjog.org.au/subiaco | Twitter | LinkedIn | Facebook

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We acknowledge the Traditional Owners of Country throughout Australia and recognise their continuing connection to land, waters and community.
We pay our respect to them and their cultures and to Elders past and present.

IMPORTANT: This email and any attachments are for the sole use of the intended recipient. They may contain confidential or privileged information. This information may not necessarily be the view of St John of God Health Care Inc (SJGHC). SJGHC does not warrant, represent or guarantee the accuracy or completeness of the information. SJGHC does not accept liability for any loss or damage in connection with the information. If you are not the intended recipient then any use, reliance, interference with, disclosure, distribution or copying of this information by you is unauthorised and prohibited. If you have received this email in error then please notify the sender by return email and delete all copies. SJGHC does not waive any privilege.

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[Michael Wishart]

Hi Mary

I wasnt sure how much historical wives tale was in this recommendation not to use CHG and PI together, so did a quick lit search. Most interesting article is a systematic review of cationic agents (CHG) and anionic agents (?PI not quite clear to me), and the possible issue of degradation of antiseptic actions.

http://jsurgdermatol.com/index.php/JSD/article/view/21

Conclusion was: Although limited evidence linking CHG incompatibility and anionic agents exists, clinicians should carefully consider the nature of topical agents used if CHG is concurrently applied. Increased awareness of CHG incompatibility may result in better antibacterial activity thus ensuring optimal patient management.

Interesting question!

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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P Please consider the environment before printing this email

From: ACIPC Infexion Connexion On Behalf Of Mary Willimann (Subiaco)
Sent: Thursday, 27 September 2018 11:51 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: Surgical site skin preparation

Dear Marg

Thanks so much for your help.

I have checked the guidelines and although there is a lot of discussion around which one to use (either CHG or PVP-I, with or without alcohol), I cant see much in regard to using both CHG and PVP-I together.

The ACORN standards state: The same antimicrobial agent shall be used for all phases of the patients skin preparation, to ensure full residual benefit and consistent action, but I have been unable to locate any reasons/evidence to support this further.

Again many thanks for any advice.

Regards
Mary

Mary Willimann CICP-E| Manager Infection Control
St John of God Subiaco Hospital
T: (08) 9382 6871 | M: 0439993772 | F: (08) 9382 6785 | E: Mary.Willimann@sjog.org.au
12 Salvado Road Subiaco WA 6008 | PO Box 14, Subiaco WA 6904
http://www.sjog.org.au/subiaco | Twitter | LinkedIn | Facebook

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We acknowledge the Traditional Owners of Country throughout Australia and recognise their continuing connection to land, waters and community.
We pay our respect to them and their cultures and to Elders past and present.

From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Marg Jennings
Sent: Thursday, 27 September 2018 6:39 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Surgical site skin preparation

Dear Mary check the national guide first. From first principles look at the pH on each and they ought be the same to avoid neutralization. what you get from chlorhex is quick and sustained activity against a narrower range of bacteria ( and some viruses) while with iodine you get a broader range of activity but it’s slower to act. That may be why the surgeons are asking for it but do refer to the national guidelines. The question to be asked is ” what is the aim of skin disinfection at the surgical site” ie what microorganisms are you requiring to disinfect”. This is important because not all anatomical sites have the same flora.
Margaret Jennings
0404088754
Marjen education services
Microbiologist and infection control educator/ consultant to office based practice

Sent from my HTC on the Telstra Mobile network

—– Reply message —–
From: “Mary Willimann (Subiaco)” <Mary.Willimann@SJOG.ORG.AU>
To: <ACIPCLIST@ACIPC.ORG.AU>
Subject: [ACIPC_Infexion_Connexion] Surgical site skin preparation
Date: Wed, Sep 26, 2018 6:19 PM

Dear Brains Trust

I have recently been asked by some of our surgeons if it is acceptable to use both alcohol based CHG and povidone-iodine solutions for surgical site skin prep; i.e. use alcoholic povidone-iodine first, allow to dry and then repeat with 2% CHG in 70% alcohol. I have always been of the understanding that this should not occur due the antiseptic effects of CHG and PVP-I being neutralised by each other, but cant seem to find enough evidence to support this. Would anyone be able to assist?

Many thanks

Mary

Mary Willimann CICP-E| Manager Infection Control

St John of God Subiaco Hospital

T: (08) 9382 6871 | M: 0439993772 | F: (08) 9382 6785 | E: Mary.Willimann@sjog.org.au

12 Salvado Road Subiaco WA 6008 | PO Box 14, Subiaco WA 6904

http://www.sjog.org.au/subiaco | Twitter<http://twitter.com/sjog_healthcare&gt; | LinkedIn<http://www.linkedin.com/company/st-john-of-god-health-care&gt; | Facebook<http://facebook.com/StJohnOfGodSubiacoHospital&gt;

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We acknowledge the Traditional Owners of Country throughout Australia and recognise their continuing connection to land, waters and community.

We pay our respect to them and their cultures and to Elders past and present.

IMPORTANT: This email and any attachments are for the sole use of the intended recipient. They may contain confidential or privileged information. This information may not necessarily be the view of St John of God Health Care Inc (SJGHC). SJGHC does not warrant, represent or guarantee the accuracy or completeness of the information. SJGHC does not accept liability for any loss or damage in connection with the information. If you are not the intended recipient then any use, reliance, interference with, disclosure, distribution or copying of this information by you is unauthorised and prohibited. If you have received this email in error then please notify the sender by return email and delete all copies. SJGHC does not waive any privilege.

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The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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