Infection prevention

Skin antisepsis

• Options
  • Alcoholic chlorhexidine (red)
  • Aqueous chlorhexidine (blue)
  • Iodine 1% / ethanol 70%
  • Povidone iodine 10%
• Chlorhexidine/alcohol solutions have better activity than povidone/iodine preparations (UTD)
• If chlorhex/alcohol is unable to used, povidone-iodine with or without alcohol is an acceptable alternative
• Only use clippers to remove hair if necessary, as it does lead to higher rates of SSI
• Abdominal wound protectors (Alexis) only makes a small difference
• Dipping the hand into a bag of chlorhex is probably more effective than painting it
• Interventions that do not seem to make a difference:
  • Using concentric circles instead of horizontal lines to apply the prep
  • Antimicrobial sealants over the skin
• My interpretation of evidence:
  • Alcoholic chlorhexidine for most wounds
  • Face: aqueous chlorhexidine or povidone-iodine (avoid combination of alcohol/oxygen/diathermy)
  • Open wounds: povidone-iodine or aqueous chlorhexidine