To pre-op or not?

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As a practitioner working for many years in the NHS I am interested to hear of any evidence based research on pre and post-op use of Chlorhexidine Gluconate 0.5% (Hydrex). My recent reading has led me to believe that the skin prep takes around 20 minutes to actually clear any skin flora and that in actual fact we are only moving the bacteria around. I also read that it has carcinogenic properties if inhaled too often - not a good thought after many years of using it in often poorly ventilated clinics (on patients feet I might add!). Some of my collegues have dispensed with this procedure and no longer pre-op prior to commencing treatment. Does anyone use anythingelse as a pre-op prep? Are we still covering ourselves as patients like to see the "antiseptic" used even if it doesn't rid the skin of bacteria? If it doesn't actually do much good then think of the financial saving to the NHS if nothing else.!
Awaiting comments / feedback!

 

I use isowipe here and I guess one wont inhale it too much as no need for spraying

 

I think Chlorhex does a good job of disinfecting....better than your research might indicate. I stopped using it do to local skin reactions (there's a thread here somewhere) and went back to using duraprep.

Steve

 

With regards to pre-opping an injection site prior to nail surgery, it is a must medico-legally.

An expert witness said about the case in which a pod surgeon did not pre-op the ankle area prior to an ankle block, and the next day it swelled up. Even though there is no evidence to suggest that pre-opping works, the claimant won £35, 000, yes £35, 000.

 

Whilst agreeing that what slight evidence does exist shows that chlorhexidine (aqueous) solution is not immediately bacteriacidal, it is still a good idea to use it. Why? Because the alcoholic solution will break down fatty acids on the skin and the wiping action will remove superficial debris/organisms. It is well known that most infective organisms are superficial, whilst those deeper in the tissues are (or act as ) commensals. An alternative might be any one of the iodine based preparations used in operating theatres, again, I would suggest the alcoholic solution.

If I may venture an opinion, I really wouldn't worry too much about the NHS budget being affected by your use of skin prep - worry more about your defence in a case of litigation.

All the best

Bill Liggins

PS, I'll be grateful if you can post your ref. on the carcinogenic effects of chlorhexidine

 

There was also a nail surgery case in which MRSA got to the spine causing lower limb paralysis. The payout: £3.5m, yes £3.5m.

The importance of record keeping/aseptic technique for nail surgery! Write batch nos/exp dates of antiseptic solutions DOWN and write in the notes WHAT they were used for.

 

We rarely prep for a nail procedure unless it's a Frost type where sutures are used.
If it is an avulsion or phenol and Alcohol or certainly an I&D we never prep.
We consider this a "dirty" procedure.

Steve

 

Not sure about anyone else? but, quite apart from anything else, I find an alcoholic wipe helpful when reducing corns and callus.

I can't use chlorhexidine gluconate in solution and I've been advised not to use Isowipes as they are for hard surfaces, so I use Sterets. Also, Betadine/iodine should be used with caution in some people (e.g. thyroid disorders).

I was interested in the suggestion that chlorhexidine gluconate was carcinogenic if it's inhaled, so I did a quick search. Admittedly, it was a really quick search, but I found no evidence to support the idea ... apart from a mention of the carcinogenic precipitate formed from the interaction between sodium hypochorite and chlorhexidine gluconate. Do you have any further info?