132 - Preoperative Skin Antisepsis: A Standardized Approach
Description: Clinical Issue A lack of standardized skin antisepsis prior to surgery was a concern discovered by the Surgical Site Infection (SSI) Steering Committee. Although we have a policy for skin antisepsis, our findings were that this was not being carried out consistently and the policy needed to be updated and improved. There was a practice and educational deficit both in the clinical area as well as in physician offices in the pre-operative process. Description of Team The Team included members of the SSI Committee: Perioperative Infection Preventionist, Nurse Educator, Leadership and staff RNs. Physician leadership, Patient Educator and the Preadmission Testing Department were consulted. Preparation and Planning The work group conducted a literature review, current pre-operative skin antisepsis policies and practice across the surgical continuum of care. Assessment SSI committee case review and observation of staff practices revealed inconsistencies in preoperative skin antisepsis. The goal of this initiative was to ensure standardization in practice across Perioperative Service Lines and to improve our policy for safe and effective skin antisepsis for all patients. Implementation Skin assessment validation was required on all pre-operative patients including whether or not patients performed skin preparation at home with an antibacterial soap or CHG If not performed at home, it would be done in the pre-op stage The updated policy promoted the use of 2% Chlorhexidine Gluconate (CHG) prior to surgical procedures in patients having Total Joint Replacement, Spine and Cardiac surgeries.Validation and documentation of home skin antisepsis was achieved by implementing a new Pre-op Skin Prep Assessment Tool in the medical record. Creation of patient education tools that promote home skin antisepsis were disseminated as a part of the pre-op process. Outcome All surgical patients are currently screened for compliance with home skin antisepsis instructions. The select group of high risk patients, including total joint replacement, spine and cardiac surgery are instructed to take a CHG shower at home the night before surgery. All other patients are instructed to shower with an antibacterial soap of choice. The Preoperative RN ensures that preoperative skin antisepsis is completed with the Skin Assessment before the patient goes to the operating room. Skin Assessment audits performed showed improved adherence to standardization of practice. Implications for Perioperative Nursing: The Peri-op nursing team was concerned that the process of assuring optimum skin antisepsis to prevent SSI’s needed improvement. With the development and implementation of a skin antisepsis program in compliance with AORN recommendations, the safety of all surgical patients is achieved. Standardization in practice across Perioperative Service Lines has improved patient care and contributes to improved patient outcomes.