Skin Antisepsis Standardization

Hospitals and institutions acknowledge that improving patient care by reducing the risk of infection is a priority, but it is a multi-factorial and complex problem, and many are unsure how to do it.

A core problem is the inconsistent implementation of proven pre-procedure preventative measures.

Saint Luke’s North Hospital in Kansas City, Mo., embarked on a collaborative effort with members of its staff to identify and implement a standardized approach to skin antisepsis with the goal of improving patient care.

Standardizing processes as a part of quality initiatives can also lead to increased satisfaction and fewer errors among healthcare professionals by eliminating variability.

Understanding Skin Antisepsis Guidelines

Patient-centered quality initiatives should begin with identifying best practices that are grounded in applicable guidelines. These guidelines outline processes, products and behavior patterns that support standards of excellence.

When institutions identify a clear action plan that adheres to these processes and behaviors with quality products and an appropriately trained staff, the result is improved patient care.

Figure 1 offers a quick reference that can help staff understand best practices for surgical skin antisepsis by highlighting appropriate information from prominent guidelines.

Selecting Appropriate Skin Antisepsis Products

When it comes to selecting a skin antiseptic to use, there are many factors to assess, such as time required, persistence, and ease and consistency of application.

For example, using a product with an applicator that promotes aseptic technique and reduces the risk of direct hand-to-patient contact would be preferred as it helps reduce the risk of cross-contamination.

Figure 2 outlines common antiseptics and how they compare in antimicrobial coverage, rapidity and persistence.

It is important to note that the skin antiseptic combination of 2% CHG and 70% IPA provides two mechanisms of action: IPA rapidly kills microorganisms by denaturing cell proteins, while CHG maintains persistent antimicrobial activity by disrupting the cell membrane and precipitating cell content.

Additionally, 2% CHG and 70% IPA combination skin antiseptics provide broad-spectrum antimicrobial activity and remain active in protein-rich biomaterials, including blood and serum; traditional iodophors are neutralized in the presence of blood and serum proteins.

Real-World Feedback: A Case Study

Saint Luke’s North Hospital celebrates a culture of safety and continuous improvement that involves a collaborative effort across clinical and financial departments.

Healthcare professionals at Saint Luke’s North Hospital noticed that there were many variables in using skin preparation products – from the type of product used to the application method or technique. This inconsistency could reduce the quality of patient care.

To address this issue, Saint Luke’s North Hospital health care professionals joined together to evaluate pre-procedure skin antiseptics and their impact on staff use and patient experience. Saint Luke’s North Hospital selected a skin antiseptic portfolio, including an one-milliliter applicator, to help reduce microorganisms on the skin.

Together, the proven formulation of 2% CHG and 70% IPA, as well as the single-use applicator, supported Saint Luke’s North Hospital’s patient-centered approach to care. The selection was validated during a survey of nurses, technicians and health care professionals between Feb. 3 and Feb. 19, 2014. The applicator was used prior to invasive procedures.

Following the application, patient and provider satisfaction was assessed. Ninety-two percent of the clinicians surveyed said the applicator was their preferred method of skin antisepsis. Key factors that contributed to this excellent rating include ease of use, ease of activation, size of applicator and overall product performance (Figure 3).

Of note, healthcare professionals also liked that the 1mL applicator sponge was soft and moist. Many of the patients included in the survey were age 65 and older with thin skin, and the soft feel and abundant liquid helped increase patient satisfaction.

Additionally, the easy-to-use, winged applicator allowed for aseptic technique and reduced the risk of direct hand-to-patient contact, which could help reduce the risk of cross-contamination. The applicator also promotes gentle friction scrub to apply the solution. With both health care professional and patient satisfied, adherence to the skin antisepsis protocol increased.

Skin Antisepsis Best Practices

Research suggests that in order to achieve optimal results, health care professionals should understand the rationale behind the choice of a particular skin antiseptic and be knowledgeable about the clinical effectiveness of an antiseptic’s use pre-procedure. Education and compliance among all healthcare professionals is essential to achieve excellence in skin preparation.

Announce the Protocol
To kick off the implementation of the standardized approach, present key findings to colleagues and provide education to heath care professionals. Also consider developing reminder visual aids, such as posters or charts that are clearly visible and readily accessed.

Take Every Opportunity to Communicate the Protocol
Reinforce the process and remind staff of the standardized protocol by reviewing the procedures each quarter. Emphasize the benefits of standardizing skin antisepsis protocols.

Try communicating through key vehicles including:

  • Monthly bulletin
  • Staff meetings
  • Signs in high-traffic areas (e.g., break rooms, staff meeting rooms) that chart evidence for each of the prepping agents

Track Progress
Finally, the act of tracking progress serves as reinforcement to staff and as a reminder of the effectiveness of standardization. Consider implementing regular tracking and compliance audits to underscore importance and measure effectiveness.

Ultimately, standardizing the skin antisepsis protocol is a collaborative effort among all members of the healthcare staff. By utilizing proven products, along with reinforced compliance and tracking, a standardized approach will result in less waste, fewer errors and improved outcomes.

References for this article can be accessed here.

Christine McElroy is an infusion nurse and vascular access specialist at Saint Luke’s North Hospital, Kansas City, Mo.

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