Asepsia y Antisepsia

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Recommended Practices for Preoperative Patient Skin Antisepsis

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he following recommended practices for preoperative patient skin antisepsis were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommendations for comments by members and others. They are effective January 1, 2008.These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented. AORN recognizes the various settings in which perioperative nurses practice. Theserecommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional operating rooms, ambulatory surgery centers, physician’s offices, cardiac catheterization laboratories, endoscopy suites, radiology departments, and all other areas where surgery may be performed. References to nursing interventions (I) used in the Perioperative NursingData Set, second edition, (PNDS) are noted in parentheses when a recommended practice corresponds to a PNDS intervention.1 The reader is referred to the PNDS for further explanation of perioperative nursing diagnoses, interventions, and outcomes.

The act of washing and rinsing removes microorganisms from the skin. Some organisms may be difficult or impossible to kill with the application of CHGalone. Staphylococcus aureus is the most common organism causing surgical site infections.2,3 In 2003, 64.4% of health care-associated Staphylococcus aureus infections were from methicillin-resistant Staphylococcus aureus (MRSA).4,5 Many surgical site infections result from colonization of the surgical site with the patient’s own flora; and colonization with Staphylococcus aureus is a known riskfactor for surgical site infection.2,6,7 Clinical trials support the use of preoperative antiseptic showers to reduce the number of microorganisms on the skin, including Staphylococcus aureus.8-11 In 1999, the Centers for Disease Control and Prevention recommend requiring patients to “shower or bathe with an antiseptic agent at least the night before the operative day” (Category IB).2 I.a. Unlesscontraindicated, patients should be instructed or assisted to perform two preoperative baths or showers with CHG before surgery to reduce the number of microorganisms on the skin and reduce the risk of subsequent contamination of the surgical wound. (PNDS: I48, I123, I104, I50, I36, I106) Four percent CHG is more effective than povidone-iodine or soap, and more than one shower is necessary toachieve maximum antiseptic effectiveness.8,9 One preoperative shower with 4% CHG was found to be twice as effective in reducing skin bacterial flora as showering with nonmedicated soap.3 Two showers with 4% CHG were found to result in lower microbial counts than showers with bar soap, medicated soap, or povidoneiodine.8,9 This greater reduction in microbial counts persisted for more than 11 hours.8 Onerandomized clinical trial found two consecutive showers or baths with 4% CHG resulted in lower surgical site infection rates than bar soap (ie, 9% versus 12.8%).9 Showering three times with 4% CHG was found to reduce skin flora 20-fold preoperatively and to lower bacterial counts of the incision taken at the end of the procedure.10

I.a.1.

Purpose These recommended practices provide aguideline for achieving skin preparation of the surgical site. The goal of preoperative preparation of the patient’s skin is to reduce the risk of postoperative surgical site infection by removing soil and transient microorganisms from the skin; reduce the resident microbial count to subpathogenic levels in a short period of time and with the least amount of tissue irritation; and inhibit rapid,...