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Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Michael
Skin preparation research and product is rapidly evolving as is our understanding of it’s role and the additional benefit of daily CHG bathing. This topic was discussed and presented in great depth at APIC 2013 and on re-listening recently to recordings of APIC sessions I took home several messages including:
1. AORN in their Standards use evidence to base preparation instructions;
2. CDC is about to release a new SSI guideline which addresses this topic and much else
3. Ultimately, clinicians need to follow manufacturers’ specific directions for their specific product
In short I don’t think there is an evidence-based “one-stop” answer to your question.
Interesting science published around this in the last 12 months in AJIC, ICHE and NEJM esp.
Cheers
CathCathryn Murphy PhD
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
[Description: twitter logo][Description: FB logo][Description: icp icon]Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailWARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
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Michael,
Seems to add unnecessary expense to me.. even if the swabs are low cost.
If skin prepping is done correctly the first time, I see no need to
‘double prep’, although I do know a clinician who does before placing a
PICC.I do have a little literature (for VA), but it’s not as current as what
you might be after.Tim..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition
ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of
Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.auBehalf Of Michael Wishart
Hi all
Can I ask a question which may seem naive to those with a recent theatre
background? When applying antiseptic solution as part of a surgical skin
preparation prior to a procedure, is it best practice to apply two
‘coats’ of antiseptic solution, one immediately on top of the other,
using different swabs?I can see not real benefit in doing this from an antiseptic action
viewpoint (apart from mechanical friction) Can also not see this
mentioned in a cursory review of any SSI prevention best practice
guidelines.Any comments? Any references to get me up-to-date if I need to be
updated?Thanks
Michael
Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email
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Dear Michael,
There is not much literature or evidence available concerning this particular question, in terms of guiding you exactly how many coats or layers you should apply.
However, some basic information can be derived from the physicochemical properties of antiseptics and of antiseptic action.
Whether there are additional “coats” (in the sense of layers) on top of each other is of relatively little relevance.
All microbial killing by disinfection and sterilisation (including antisepsis) is a time-dependent action. You can see that from “time-kill-curves” of microorganisms when exposed to these processes. Figures are, for example, in the Gardner & Peel textbook, which is an Australian reference. The time-dependent nature of microbial killing is the conceptual reason for having contact times with any antisepsis or disinfection process.
Repeated applications of antiseptics for the purpose of skin antisepsis simply help to keep sufficient fresh antiseptic on the skin site in order for it to be antimicrobially effective for the duration of the contact time. It is a simple physical principle that if the site is not wet with the antiseptic (e.g. by evaporation), it cannot act.
The Australian College of Surgeons (RACS) has an earlier guideline on infection prevention in surgery (not sure if this has been updated) that says “at least 2, but preferably 5 minutes” of contact time of the antiseptic for surgical skin prep.
Clearly recognising that this is arbitrary, not guided by good evidence and up for debate, what I have recommended in the past is to have 3 repeated applications, providing an overall contact time, including evaporation at the end of the applications, of 5 minutes. The rationale for this recommendation is that this would be consistent with the RACS recommendation of 5 min (for major surgery you want to err on the side of greater caution) and consistent with the physicochemical properties.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailWARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
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[cid:kkh29.gif]kkh
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Michael,
I believe that using the solution according to manufacturers instructions,
and leaving the solution to ‘dry’ on the patient’s skin prior to incision
will facilitate optimal ‘kill’ time and negate the need to a second ‘pass’
with the solution.
Best wishes*Jackie *
*Jackie Miley* MSc, PG Cert Public Health, Cert Infection Control,
Dip Rn. Practice EducatorSenior Lecturer Infection Prevention and Control
Subject Coordinator MSc Infection Prevention and ControlOxford Brookes University
Faculty of Health and Life Sciences
Room S1/12
Department of Biological and Medical Sciences
Gipsy Lane Campus
Headington
Oxford OX3 0BP*Coordinator – Audit and Surveillance Forum. Infection Prevention Society
UK.*On 19 July 2013 03:12, Tim Spencer wrote:
> Michael,****
>
> Seems to add unnecessary expense to me.. even if the swabs are low cost.**
> **
>
> If skin prepping is done correctly the first time, I see no need to
> double prep, although I do know a clinician who does before placing a
> PICC.****
>
> I do have a little literature (for VA), but its not as current as what
> you might be after.****
>
> Tim..****
>
> ** **
>
> *Timothy R. Spencer**, RN, APN, DipAppSci, Bach.Health, ICCert.
> **Clinical Nurse Consultant, * Central Venous Access & Parenteral
> Nutrition Service****
>
> *Conjoint Lecturer, *South West Sydney Clinical School | Faculty of
> Medicine |* *University of NSW
> Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
> Elizabeth Street, Liverpool, 2170, NSW, Australia
> Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
> Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
> [image: 200 yeas logo white.jpg]****
>
> ** **
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Michael Wishart
> *Sent:* Friday, 19 July 2013 11:57 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Surgical skin prepping****
>
> ** **
>
> Hi all****
>
> ** **
>
> Can I ask a question which may seem naive to those with a recent theatre
> background? When applying antiseptic solution as part of a surgical skin
> preparation prior to a procedure, is it best practice to apply two coats
> of antiseptic solution, one immediately on top of the other, using
> different swabs?****
>
> ** **
>
> I can see not real benefit in doing this from an antiseptic action
> viewpoint (apart from mechanical friction) Can also not see this mentioned
> in a cursory review of any SSI prevention best practice guidelines.****
>
> ** **
>
> Any comments? Any references to get me up-to-date if I need to be updated?
> ****
>
> ** **
>
> Thanks****
>
> Michael****
>
> ** **
>
> *Michael Wishart*****
>
> *CNC Infection Control*****
>
> *Holy Spirit Northside Private Hospital*****
>
> 627 Rode Road, Chermside, Qld 4032 ****
>
> *t:* (07) 3326 3068 | *f:* (07) 3607 2226 ****
>
> *e:** *Michael.Wishart@hsn.org.au****
>
> *w:*www.holyspiritnorthside.org.au****
>
> Please consider the environment before printing this email****
>
> ** **
>
> ** **
>
>
> _____________________________________________________________________
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> Health Districts by the MessageLabs Email Security System.
> Sydney & South Western Sydney Local Health Districts regularly monitor
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Hi Michael,
I currently don’t have access to the ACORN Standards to check what they
are saying in the 2012 edition.However, as a trainee perioperative nurse, I was taught the principle was
to prep from the proposed incision site to the edges of the operative
field with one swab. This was then discarded as it was assumed to be
heavily contaminated with skin organisms.A second swab was then used to apply the antiseptic to the area, once
again starting at the proposed incision site and working outwards. This
second pass was performed to ensure that the contact time of the
antiseptic met manufacturer’s recommendations in addition to being thought
to add to the antimicrobial activity against any organisms not contacted
in the first episode of skin preparation.As Mathias rightly points out, achievement of the desired level of
disinfection / skin antisepsis [as with sterilisation] is largely
dependent on the initial number of organisms present. The more you start
with the less likely you are to reduce their numbers sufficiently with
just one application.Regards
Terry McAuley
Sterilisation and Infection Prevention & Control Consultant
STEAM Consulting> Hi all
>
> Can I ask a question which may seem naive to those with a recent theatre
> background? When applying antiseptic solution as part of a surgical skin
> preparation prior to a procedure, is it best practice to apply two ‘coats’
> of antiseptic solution, one immediately on top of the other, using
> different swabs?
>
> I can see not real benefit in doing this from an antiseptic action
> viewpoint (apart from mechanical friction) Can also not see this mentioned
> in a cursory review of any SSI prevention best practice guidelines.
>
> Any comments? Any references to get me up-to-date if I need to be updated?
>
> Thanks
> Michael
>
> Michael Wishart
> CNC Infection Control
> Holy Spirit Northside Private Hospital
> 627 Rode Road, Chermside, Qld 4032
> t: (07) 3326 3068 | f: (07) 3607 2226
> e: Michael.Wishart@hsn.org.au
> w:www.holyspiritnorthside.org.au
> Please consider the environment before printing this email
>
>
> —
> WARNING : This email contains information, which is CONFIDENTIAL, and that
> maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it
> (the “Communication”) is confidential and is for the use only of the
> intended recipient, and may not duplicated or used by any other party
> without the express consent of the sender. The Communication may contain
> copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of
> its related entities or of third parties. If you are not the intended
> recipient of the Communication, please notify the sender immediately by
> return e-mail, delete the Communication, and do not read, copy, print,
> retransmit, store or act in reliance on the Communication. Any views
> expressed in the Communication are those of the individual sender only,
> unless expressly stated to be those of SVHAC. SVHAC does not guarantee the
> integrity of the Communication, or that it is free from errors, viruses or
> interference. Thank-you.
>
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>
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Hi Michael
Standard S18 of the ACORN standards covers this[stlukesbutterfly] James Harrison
Manager Clinical Services[stlukes]
tel : 03 6331 9255
fax : 03 6334 0711
web : http://www.stlukes.com.au
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P Please consider the environment before you print this email.Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Dear James,
I am curious. What does it say?
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387Hi Michael
Standard S18 of the ACORN standards covers this[stlukesbutterfly] James Harrison
Manager Clinical Services[stlukes]
tel : 03 6331 9255
fax : 03 6334 0711
web : http://www.stlukes.com.au
17 Quadrant Mall , Launceston, TAS 7250“This email (which includes any attachments) is intended only for the use of the individual or entity named above and may contain information that is confidential and privileged. If you are not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this email is strictly prohibited. If you are the intended recipient of this communication you should not copy, disclose or distribute this communication without the authority of St.LukesHealth.
Any views expressed in this communication are those of the individual sender, except where the sender specifically states them to be the views of St.LukesHealth. St.LukesHealth can not guarantee that this communication has not been intercepted or that the communication is virus free, although reasonable steps have been taken to protect the integrity of our email. If you have received this email in error, please notify us immediately by return email or telephone (03) 6331 9255 and destroy the original message. Thank you.
P Please consider the environment before you print this email.Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailWARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
________________________________
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[cid:kkh777d.gif]kkh
________________________________
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Dear Matthias
it makes reference to starting at the cleanest area(incision site) and working concentrically to least clean area, also to avoid ‘drying’ with swabs sponges. its 5 pages long with 15 references
kind regards
James[stlukesbutterfly] James Harrison
Manager Clinical Services[stlukes]
tel : 03 6331 9255
fax : 03 6334 0711
web : http://www.stlukes.com.au
17 Quadrant Mall , Launceston, TAS 7250“This email (which includes any attachments) is intended only for the use of the individual or entity named above and may contain information that is confidential and privileged. If you are not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this email is strictly prohibited. If you are the intended recipient of this communication you should not copy, disclose or distribute this communication without the authority of St.LukesHealth.
Any views expressed in this communication are those of the individual sender, except where the sender specifically states them to be the views of St.LukesHealth. St.LukesHealth can not guarantee that this communication has not been intercepted or that the communication is virus free, although reasonable steps have been taken to protect the integrity of our email. If you have received this email in error, please notify us immediately by return email or telephone (03) 6331 9255 and destroy the original message. Thank you.
P Please consider the environment before you print this email.Dear James,
I am curious. What does it say?
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387Hi Michael
Standard S18 of the ACORN standards covers this[stlukesbutterfly] James Harrison
Manager Clinical Services[stlukes]
tel : 03 6331 9255
fax : 03 6334 0711
web : http://www.stlukes.com.au
17 Quadrant Mall , Launceston, TAS 7250“This email (which includes any attachments) is intended only for the use of the individual or entity named above and may contain information that is confidential and privileged. If you are not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this email is strictly prohibited. If you are the intended recipient of this communication you should not copy, disclose or distribute this communication without the authority of St.LukesHealth.
Any views expressed in this communication are those of the individual sender, except where the sender specifically states them to be the views of St.LukesHealth. St.LukesHealth can not guarantee that this communication has not been intercepted or that the communication is virus free, although reasonable steps have been taken to protect the integrity of our email. If you have received this email in error, please notify us immediately by return email or telephone (03) 6331 9255 and destroy the original message. Thank you.
P Please consider the environment before you print this email.Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailWARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
________________________________
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[cid:kkh777d.gif]kkh
________________________________
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Michael and all
In my research I am currently reviewing the draft US CDC Surgical Site Infection Guidelines which are due to be released in Nov 2013. They include comprehensive review of literature and rigorous grading of evidence for every recommendation. Guidance in this issue like many areas of infection prevention often becomes outdated due to new technologies and formulations. Misinterpretation, multi-resistant attitudes and holding onto sacred cows continue to plague effective clinical practice. The CDC draft statement regarding skin antisepsis suggests that multi applications may be one such sacred cow. The draft recommendation below is subject to normal HICPAC consultation processes.
Always interesting to see how public policy evolves, usually much slower and less responsive than technology and adoption of trends and fads. All of this keeps our role exciting and very necessary.
JUNE 2013 NEW
8A. Require patients to shower or bathe (full body-including scalp) on at least the night before the operative day (Category IB)
8A.1. No recommendation can be made regarding the safety and effectiveness of specific body cleansing products, the optimal timing or number of product applications. (No recommendation/unresolved issue)Cath
Cathryn Murphy PhD
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
[Description: twitter logo][Description: FB logo][Description: icp icon]Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailWARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
________________________________
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Thanks Cath, very interesting. But this appears to be about pre-op antiseptic body wash rather than pre-op skin antisepsis. Is there any proposed change to the HICPAC guidelines about skin antisepsis? Presume they will at least have a statement about following antiseptic manufacturer’s instructions for application?
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailMichael and all
In my research I am currently reviewing the draft US CDC Surgical Site Infection Guidelines which are due to be released in Nov 2013. They include comprehensive review of literature and rigorous grading of evidence for every recommendation. Guidance in this issue like many areas of infection prevention often becomes outdated due to new technologies and formulations. Misinterpretation, multi-resistant attitudes and holding onto sacred cows continue to plague effective clinical practice. The CDC draft statement regarding skin antisepsis suggests that multi applications may be one such sacred cow. The draft recommendation below is subject to normal HICPAC consultation processes.
Always interesting to see how public policy evolves, usually much slower and less responsive than technology and adoption of trends and fads. All of this keeps our role exciting and very necessary.
JUNE 2013 NEW
8A. Require patients to shower or bathe (full body-including scalp) on at least the night before the operative day (Category IB)
8A.1. No recommendation can be made regarding the safety and effectiveness of specific body cleansing products, the optimal timing or number of product applications. (No recommendation/unresolved issue)Cath
Cathryn Murphy PhD
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
[Description: twitter logo][Description: FB logo][Description: icp icon]Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailWARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
________________________________
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________________________________
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http://www.mailguard.com.auReport this message as spam
—
WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.
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Michael
CDC does not typically drill down to the minutia level of applications. Under FDA and OSHA legislation I am sure that the assumptions rightly or wrongly are that manufacturers label as per their submission for registration and testing and that clinicians follow label instructions. Australia is no different.
Below is an interesting point about intraoperative skin prep and solution of choice.
There are also many in-press publications about CHG bathing pre-operatively as an additional measure.
We have to remain on top of all this research and public policy and it’s very time consuming and not easy without formal training in reading and understanding scientific papers. Our lot in life I guess.
JUNE 2013 UPDATED
8B. Perform intraoperative skin preparation with an appropriate antiseptic agent. (Category IA)
8B.1.a. Use chlorhexidine gluconate-alcohol in preference of aqueous iodophor skin preparation, unless contraindicated. (Category IA)
8B.1.b. No recommendation can be made regarding the safety and effectiveness of chlorhexidine gluconate-alcohol as compared to iodophor-alcohol skin preparation.(No recommendation/unresolved issue)Cheers
CathThanks Cath, very interesting. But this appears to be about pre-op antiseptic body wash rather than pre-op skin antisepsis. Is there any proposed change to the HICPAC guidelines about skin antisepsis? Presume they will at least have a statement about following antiseptic manufacturer’s instructions for application?
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailMichael and all
In my research I am currently reviewing the draft US CDC Surgical Site Infection Guidelines which are due to be released in Nov 2013. They include comprehensive review of literature and rigorous grading of evidence for every recommendation. Guidance in this issue like many areas of infection prevention often becomes outdated due to new technologies and formulations. Misinterpretation, multi-resistant attitudes and holding onto sacred cows continue to plague effective clinical practice. The CDC draft statement regarding skin antisepsis suggests that multi applications may be one such sacred cow. The draft recommendation below is subject to normal HICPAC consultation processes.
Always interesting to see how public policy evolves, usually much slower and less responsive than technology and adoption of trends and fads. All of this keeps our role exciting and very necessary.
JUNE 2013 NEW
8A. Require patients to shower or bathe (full body-including scalp) on at least the night before the operative day (Category IB)
8A.1. No recommendation can be made regarding the safety and effectiveness of specific body cleansing products, the optimal timing or number of product applications. (No recommendation/unresolved issue)Cath
Cathryn Murphy PhD
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
[Description: twitter logo][Description: FB logo][Description: icp icon]Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailWARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
________________________________
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Hi Cath, hi Michael,
I agree with Michael — not that Cath was fundamentally different on that issue — that (a) classical skin antisepsis before surgical incision (‘surgical skin prep’) and (b) antiseptic body washing or showering in the preoprerative phase (that includes preoperative antiseptic body wiping with cloths) are two fundamentally different processes, both biologically and clinically.
Classical skin antisepsis is extremely well supported by evidence plus carries a clear scientific rationale:
(1) Historically, skin antisepsis before iatrogenic skin breaks has been used since the 1890s (e.g. a paper by Harrington & Walker 1903 stated it was in widespread use).
(2) There is a clear biological and microbiological theoretical framework supporting it, i.e. there is biological plausibility. This includes the fact that well-conducted skin antisepsis reduces microbe counts on skin by anywhere between 2 log and 4 log (a factor of 100-10,000) and that microorganisms from patients’ skin are known to cause surgical site infections.
(3) That based on microbiological testing — both in reagent tubes and on real skin — antiseptics can be categorised (that includes regulatory purposes by product approval agencies) into stronger and weaker ones, and some that pass standards and others that don’t.
(4) That outcomes from clinical trials, including very well conducted (i.e. high-level evidence) randomised clinical trials by and large reflect the outcomes from microbiological testing.
So, we have various angles of strong support here.Preoperative antiseptic body washing is much less supported overall. This is also reflected by the statement in the draft text passage that Cath sent, saying that although showering or bathing should be done (note, no antiseptic stated here), it says “No recommendation can be made regarding the safety and effectiveness of specific body cleansing products, the optimal timing or number of product applications.” That means the draft does not necessarily imply that this should be done with antiseptics. The use of antiseptics for that purpose follows a reasonably good rationale and has biological plausibility, but support from high-quality randomised clinical trials is currently lacking. The latter also became clear in a recently-updated Cochrane review by Webster & Osborne (authors from QLD) in 2012. Microbiologically, antiseptic body washing achieves far lesser microbial reduction on skin than classical skin antisepsis. There are several other non-randomised (e.g. observational) clinical studies showing a benefit from antiseptic washing, and they should definitely not be discounted. These are still providing valuable evidence. But the evidence from the latter type of studies is not quite as clear-cut as one would wish, just as an example, by coincidence there were two almost back-to-back recently-appeared (but in different journals) papers, one by Kapadia et al. 2013, the other by Farber et al. 2013. One was antiseptic-industry-supported, the other not. The industry-supported paper showed a benefit, the other not. Just a few interesting observations here . . .
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387Michael
CDC does not typically drill down to the minutia level of applications. Under FDA and OSHA legislation I am sure that the assumptions rightly or wrongly are that manufacturers label as per their submission for registration and testing and that clinicians follow label instructions. Australia is no different.
Below is an interesting point about intraoperative skin prep and solution of choice.
There are also many in-press publications about CHG bathing pre-operatively as an additional measure.
We have to remain on top of all this research and public policy and it’s very time consuming and not easy without formal training in reading and understanding scientific papers. Our lot in life I guess.
JUNE 2013 UPDATED
8B. Perform intraoperative skin preparation with an appropriate antiseptic agent. (Category IA)
8B.1.a. Use chlorhexidine gluconate-alcohol in preference of aqueous iodophor skin preparation, unless contraindicated. (Category IA)
8B.1.b. No recommendation can be made regarding the safety and effectiveness of chlorhexidine gluconate-alcohol as compared to iodophor-alcohol skin preparation.(No recommendation/unresolved issue)Cheers
CathThanks Cath, very interesting. But this appears to be about pre-op antiseptic body wash rather than pre-op skin antisepsis. Is there any proposed change to the HICPAC guidelines about skin antisepsis? Presume they will at least have a statement about following antiseptic manufacturer’s instructions for application?
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailMichael and all
In my research I am currently reviewing the draft US CDC Surgical Site Infection Guidelines which are due to be released in Nov 2013. They include comprehensive review of literature and rigorous grading of evidence for every recommendation. Guidance in this issue like many areas of infection prevention often becomes outdated due to new technologies and formulations. Misinterpretation, multi-resistant attitudes and holding onto sacred cows continue to plague effective clinical practice. The CDC draft statement regarding skin antisepsis suggests that multi applications may be one such sacred cow. The draft recommendation below is subject to normal HICPAC consultation processes.
Always interesting to see how public policy evolves, usually much slower and less responsive than technology and adoption of trends and fads. All of this keeps our role exciting and very necessary.
JUNE 2013 NEW
8A. Require patients to shower or bathe (full body-including scalp) on at least the night before the operative day (Category IB)
8A.1. No recommendation can be made regarding the safety and effectiveness of specific body cleansing products, the optimal timing or number of product applications. (No recommendation/unresolved issue)Cath
Cathryn Murphy PhD
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
[Description: twitter logo][Description: FB logo][Description: icp icon]Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailWARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
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Just out of interest, we looked at skin antisepsis in this recent article looking at CVC insertion as part of a systematic review.
http://www.swslhd.nsw.gov.au/Liverpool/CVAS%5Ccontent/pdf/Articles/Yacopett_et_al_2013.pdf
Regards,
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel 02 8738 3603 | Fax 02 8738 3551 | Mob +61(0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au—–Original Message—–
Hi Cath, hi Michael,I agree with Michael — not that Cath was fundamentally different on that issue — that (a) classical skin antisepsis before surgical incision (‘surgical skin prep’) and (b) antiseptic body washing or showering in the preoprerative phase (that includes preoperative antiseptic body wiping with cloths) are two fundamentally different processes, both biologically and clinically.
Classical skin antisepsis is extremely well supported by evidence plus carries a clear scientific rationale:
(1) Historically, skin antisepsis before iatrogenic skin breaks has been used since the 1890s (e.g. a paper by Harrington & Walker 1903 stated it was in widespread use).
(2) There is a clear biological and microbiological theoretical framework supporting it, i.e. there is biological plausibility. This includes the fact that well-conducted skin antisepsis reduces microbe counts on skin by anywhere between 2 log and 4 log (a factor of 100-10,000) and that microorganisms from patients’ skin are known to cause surgical site infections.
(3) That based on microbiological testing — both in reagent tubes and on real skin — antiseptics can be categorised (that includes regulatory purposes by product approval agencies) into stronger and weaker ones, and some that pass standards and others that don’t.
(4) That outcomes from clinical trials, including very well conducted (i.e. high-level evidence) randomised clinical trials by and large reflect the outcomes from microbiological testing.
So, we have various angles of strong support here.Preoperative antiseptic body washing is much less supported overall. This is also reflected by the statement in the draft text passage that Cath sent, saying that although showering or bathing should be done (note, no antiseptic stated here), it says “No recommendation can be made regarding the safety and effectiveness of specific body cleansing products, the optimal timing or number of product applications.” That means the draft does not necessarily imply that this should be done with antiseptics. The use of antiseptics for that purpose follows a reasonably good rationale and has biological plausibility, but support from high-quality randomised clinical trials is currently lacking. The latter also became clear in a recently-updated Cochrane review by Webster & Osborne (authors from QLD) in 2012. Microbiologically, antiseptic body washing achieves far lesser microbial reduction on skin than classical skin antisepsis. There are several other non-randomised (e.g. observational) clinical studies showing a benefit from antiseptic washing, and they should definitely not be discounted. These are still providing valuable evidence. But the evidence from the latter type of studies is not quite as clear-cut as one would wish, just as an example, by coincidence there were two almost back-to-back recently-appeared (but in different journals) papers, one by Kapadia et al. 2013, the other by Farber et al. 2013. One was antiseptic-industry-supported, the other not. The industry-supported paper showed a benefit, the other not. Just a few interesting observations here . . .
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387Michael
CDC does not typically drill down to the minutia level of applications. Under FDA and OSHA legislation I am sure that the assumptions rightly or wrongly are that manufacturers label as per their submission for registration and testing and that clinicians follow label instructions. Australia is no different.
Below is an interesting point about intraoperative skin prep and solution of choice.
There are also many in-press publications about CHG bathing pre-operatively as an additional measure.
We have to remain on top of all this research and public policy and it’s very time consuming and not easy without formal training in reading and understanding scientific papers. Our lot in life I guess.
JUNE 2013 UPDATED
8B. Perform intraoperative skin preparation with an appropriate antiseptic agent. (Category IA)
8B.1.a. Use chlorhexidine gluconate-alcohol in preference of aqueous iodophor skin preparation, unless contraindicated. (Category IA)
8B.1.b. No recommendation can be made regarding the safety and effectiveness of chlorhexidine gluconate-alcohol as compared to iodophor-alcohol skin preparation.(No recommendation/unresolved issue)Cheers
CathThanks Cath, very interesting. But this appears to be about pre-op antiseptic body wash rather than pre-op skin antisepsis. Is there any proposed change to the HICPAC guidelines about skin antisepsis? Presume they will at least have a statement about following antiseptic manufacturer’s instructions for application?
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailMichael and all
In my research I am currently reviewing the draft US CDC Surgical Site Infection Guidelines which are due to be released in Nov 2013. They include comprehensive review of literature and rigorous grading of evidence for every recommendation. Guidance in this issue like many areas of infection prevention often becomes outdated due to new technologies and formulations. Misinterpretation, multi-resistant attitudes and holding onto sacred cows continue to plague effective clinical practice. The CDC draft statement regarding skin antisepsis suggests that multi applications may be one such sacred cow. The draft recommendation below is subject to normal HICPAC consultation processes.
Always interesting to see how public policy evolves, usually much slower and less responsive than technology and adoption of trends and fads. All of this keeps our role exciting and very necessary.
JUNE 2013 NEW
8A. Require patients to shower or bathe (full body-including scalp) on at least the night before the operative day (Category IB)
8A.1. No recommendation can be made regarding the safety and effectiveness of specific body cleansing products, the optimal timing or number of product applications. (No recommendation/unresolved issue)Cath
Cathryn Murphy PhD
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
[Description: twitter logo][Description: FB logo][Description: icp icon]Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailWARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
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