Pre-Operative Antisepsis Protocol Compliance and the Effect on Bacterial Load Reduction

Area of Science:

• Surgical Site Infection Prevention
• Antimicrobial Efficacy
• Healthcare Protocol Adherence

Background:

• Surgical site infections (SSIs) are a significant concern, with skin preparation being a critical preventive measure.
• Variability in antiseptic product usage and adherence to manufacturer guidelines may compromise bacterial load reduction.
• Standardization of surgical skin preparation protocols is crucial for effective infection control.

Purpose of the Study:

• To investigate the adherence to manufacturer guidelines for surgical skin antiseptics.
• To evaluate the impact of protocol adherence on bacterial load reduction.
• To compare the efficacy of Chlorhexidine gluconate-isopropyl alcohol (CHG-IPA) and povidone-iodine (PVI) in reducing bacterial load.

Main Methods:

• Thirty surgical staff from four hospitals prepared skin using CHG-IPA and PVI on standardized patients.
• Performance was assessed against manufacturer guidelines using checklists.
• Bacterial loads (CFUs) were measured via swabs taken pre-prep, and at 1 and 30 minutes post-prep.

Main Results:

• No participant achieved 100% adherence to manufacturer guidelines.
• Essential steps were followed by 90% for CHG-IPA versus 33.3% for PVI (p=0.0001).
• No significant difference in bacterial reduction was observed between CHG-IPA and PVI at 30 minutes (75.2% vs. 73.7%, p=0.7662).
• Bacterial reduction did not correlate with experience, protocol compliance, or prep time.

Conclusions:

• Significant incongruence exists in pre-operative skin preparation compared to manufacturer guidelines.
• Current deviations did not demonstrably affect immediate bacterial load reduction, though larger studies may be needed.
• Standardization, simplification, and education on surgical skin preparation techniques are recommended to enhance protocol compliance.