Surgical site infections (SSIs) are the most common cause of health care associated infections. As part of our campaign to reduce SSIs at UT Southwestern Medical Center in Dallas, TX, we sought out to audit skin prep practices with the initial focus on application technique and a secondary focus on choice of product.
Methods: Infection Prevention for the University hospitals audited appropriateness of skin prep for compliance with manufacturer's directions and whether sufficient drying time was allowed. Skin prep was done appropriately less than 50% of the time. BD assessed skin prep practices in May 2017 using a standardized observation tool that evaluated method, prep time, compliance to prep time, dry time and compliance to dry time for ChloraPrep, Duraprep, and other CHG and Iodine solutions. Prep time and dry time were measured and compliance was calculated as a percentage.
Results: A total of 51 cases were observed. ChloraPrep was used most often, followed by 2 step PVP Scrub & Paint, CHG and DuraPrep. ChloraPrep was applied correctly 44% of the time and DuraPrep 0% of the time. ChloraPrep prep time was compliant only 6% of the time. Dry time compliance was 45% for ChloraPrep and 50% for DuraPrep. Overall application method was correct 41% of the time, proper prep time 3% (compared to a national average of 44%), proper dry time of 41%. A skin prep task force worked to simplify the products available and clarified instructions for use. Inservice training programs were developed. Nursing educators developed an audit and competency tool for monitoring.
The correct application technique, prep time and dry time were adhered to in less than 50% of the observations. Of interest is that national averages for all of these categories were <50% as well. The results of the assessment at UT Southwestern are not unique and reflect a larger issue in how skin prep is performed across the country. It became clear that doing a deeper dive to understand the barriers in implementing appropriate skin prep practices was necessary. We were able to simplify the various products available to surgical staff, provide consistent recommendations on directions for use and provide hands on teaching to ensure competency. We hope to be able to identify a cost savings in addition to showing a reduction in surgical site infections.
B. Crim, None
L. Pearson, BD: Employee , Salary .
L. Williams, BD: Employee , Salary .
D. Arocha, None
J. Trivedi, None