Skin Prep problems

Re: Skin Prep problems

Rob Watkins — Fri, 10 Oct 2014 09:28:23 GMT

[quote user="Nicola Lawlor"]

We use neat chlorhexidine on damp cotton wool to prep patients too - it is how our nurses are taught at college to do it. It is wiped with a diluted chlorhexidine solution after the appropriate cleaning/contact time is done, then sprayed with surgical spirit. We very rarely have any sort of skin reactions from patients and when we do they are usually clipper related.

[/quote]

Interesting Nicola..... How do you identify that they are usually clipper related?

Re: Skin Prep problems

Gillian Mostyn — Thu, 09 Oct 2014 00:13:13 GMT

Just clean, not sterile. I do remember them having a pretty persuasive argument, hence why we changed from cotton wool, but I have to admit I don't remember the details exactly. Something about the cotton wool reducing the effectiveness of the scrub solution and the reduced risk of leaving fibres behind with swabs. I'd agree that they can be abrasive if the prep is over zealous though.

Re: Skin Prep problems

Michael Woodhouse — Thu, 09 Oct 2014 00:09:17 GMT

[quote user="Gillian Mostyn"]

Nurses are usually taught at college NOT to use cotton wool....just gauze swabs.

[/quote]

Why? Just fresh from the pack or sterile?

I only use swabs to clean grimy (usually farm dogs) with dirt ingrained into the skin. They are far more abrasive on the skin. We try not to cause irritation or redness as I understood it can encourage bacteria out of the pores.

Re: Skin Prep problems

Gillian Mostyn — Thu, 09 Oct 2014 00:05:39 GMT

Nurses are usually taught at college NOT to use cotton wool....just gauze swabs.

Re: Skin Prep problems

Nicola Lawlor — Wed, 08 Oct 2014 20:45:14 GMT

[quote user="Michael Woodhouse"]We can't be the only practice using damp cotton wool with the Hibiscrub squirted directly onto it? We don't make up a solution of any given percentage, and everywhere I saw practice or have worked did it this way. Therefore more than 80% of practices I have been in have no idea of the concentration. I don't know what concentration is on my skin either......[/quote]

Re: Skin Prep problems

Linda Filshie — Wed, 08 Oct 2014 16:53:00 GMT

I've always used a 1:10 dilution (roughly) of chlorhexidine. I have no idea where I got that figure from - I may even have made it up!

Re: Skin Prep problems

Michael Woodhouse — Wed, 08 Oct 2014 13:35:47 GMT

[quote user="Rob Watkins"]However a study in 2009 showed that only 21% of veterinary nurses could state the dilution rate of the antiseptic agent they were using (regardless if it was correct or not).[/quote]

We can't be the only practice using damp cotton wool with the Hibiscrub squirted directly onto it? We don't make up a solution of any given percentage, and everywhere I saw practice or have worked did it this way. Therefore more than 80% of practices I have been in have no idea of the concentration. I don't know what concentration is on my skin either......

Re: Skin Prep problems

Andrew Mellor — Wed, 08 Oct 2014 11:14:16 GMT

[quote user="Julian Earl"]

Are you having reactions in just dogs or catsas well? About 30+ years ago there were letters in the Vet Record about cats reacting extremely badly to being scrubbed with Savlon which includes chlorhexidine of course. I wasn't a vet then, I'm not quite that old but remember seeing the letters when working at a vet's as my weekend job. Report them as adverse reactions all the same. The cats then were sloughing skin around their spey wound and the Savlon was being blamed.

[/quote]

Just dogs , I agree with the clipper rash argument and will see tram lines on occasions but in some of these cases the none clipped surrounding skin has reacted too, as a guess I would say the nurses actually use less than 2 % solution , rather than it being too strong.

how may people have moved on to the chloraprep scrub sponges?

Re: Skin Prep problems

Rob Watkins — Wed, 08 Oct 2014 10:19:24 GMT

The most commonly used agent for patient skin preparation in National Health Service is now chlorhexidine.

This changed when the Health Protection Agency produced a level 1 recommendation

Based on a 2010 study.

In terms of reactions to hibiscrub, clippers are often to blame as cleaning and maintenace between patients is often neglegted.

However a study in 2009 showed that only 21% of veterinary nurses could state the dilution rate of the antiseptic agent they were using (regardless if it was correct or not).

I hypothesise that 79% answered the question "a pinky colour".

It would be worth standardising the dilution rate.

As a guide to patient prep nurses find this a good read and is what we do at practice demonstrations.

Re: Skin Prep problems

Julian Earl — Tue, 07 Oct 2014 23:53:27 GMT

Re: Skin Prep problems

Anthony Todd — Tue, 07 Oct 2014 22:52:41 GMT

[quote user="Nicola M"]Could it be enthusiastic clipper blade related rather than the hibi? Personally prefer iodine based.

[/quote]

Been there, usually when the clipper blades have been resharpened so that the comb teeth are very sharp at the ends.

Usually gives linear abrasions so easy to distinguish if you look closely. I used to smooth the sharp comb tips with, say, 400 or 800 grit wet and dry.

We had some serious reactions when whatever skin prep was too concentrated [er, by a factor of 10 or 100....]

Re: Skin Prep problems

David Mills — Tue, 07 Oct 2014 22:45:33 GMT

[quote user="Michael Woodhouse"]

I'm intrigued by people moving from hibi to iodine. We went the other way due to the theoretical advantage of persistence.

[/quote]

The understandingis you either clean the skin well or not. That is the main determinant. Maybe persistence can cover for some 'deficiency' in this - maybe.. But the contamination from the air, clothing, breath is infinitesimal when compared to the initial skin prep.

Re: Skin Prep problems

Nicola Lawlor — Tue, 07 Oct 2014 22:21:29 GMT

I agree, check your clipper blades if you are having that many cases react like this. If you are satisfied that there is no issue there then I would talk to the manufacturer of your chlorhexidine and see if they are willing to assist you further in checking the product?

Re: Skin Prep problems

Michael Woodhouse — Tue, 07 Oct 2014 21:31:28 GMT

I'm intrigued by people moving from hibi to iodine. We went the other way due to the theoretical advantage of persistence.

Re: Skin Prep problems

Nicola Cole — Tue, 07 Oct 2014 20:32:48 GMT

Could it be enthusiastic clipper blade related rather than the hibi? Personally prefer iodine based.

Re: Skin Prep problems

David Mills — Tue, 07 Oct 2014 20:12:14 GMT

I love iodine for everything. It's the most commonly used skin prep in human surgery partly because it is visible as part of a safety check I.e. Things have been scrubbed. If you're worried about mess, just get a bottle of hydrogen peroxide and clean it with that- takes about 5 seconds to get rid of it post op (same goes for blood).

Re: Skin Prep problems

Martin Atkinson — Tue, 07 Oct 2014 18:21:56 GMT

We use Povidone iodine for skin prep. We used to use chlorhexidine but had a couple of wound infections in succession and a nurse who reacted to it so it was just one thing we changed as part of a review. I do however still use it for scrubbing my own hands. I can't see why it should make any more of a mess than anything else - at least you can see the mess to clean it up and it goes colourless on the animal's coat after a short while anyway.