Skin Prep

Principles to consider
1. Spectrum
2. Duration of action
3. Toxicity

There is little data to suggest any one is better than any other.

Alcohol
Rapid onset, good spectrum, modestly long duration.
But dries skin and flammable.

Betadine / Providine-iodine
Kills 99%, good spectrum.
Minimal irritation, but short duration of action.

Chlorhexidine
Poor against viruses and TB, otherwise good spectrum.
Safe with good duration of activity.
Kills 99.9% of microbes.
Severely toxic if contacts middle ear or cornea.

Hexachlorophene
Long acting, but poor vs gram -ves
And actively absorbed, can lead to CNS toxicity.

Hand Scrub Principles
5 minutes is long enough.
- in fact in-vitro, 1 minute is enough (1).
A 3-5 minute scrub for the first and 2-3 minutes subsequently is advisable (2).

Prepping the Pt
1. A pre-op shower on the evening before with chlorhexidine is beneficial.
2. Remove hair immediately prior to the operation - if earlier, bacteria grow in the nicks and infection rates increase
- use clippers, not razor.
- hair does not contribute to higher infection rates, so only remove if it interferes with the operation or closure.
3. Mechanical wash: vigorously wash with soap-based iodophore or scrub to remove contaminants, in spiral-outward motion.
- thoroughly wash the umbilicus.
4. New sponge; paint with disinfectant.\

References
Surg Gynecol Obstet 1969;129:1181.
Deitch.  Tools of the Trade.