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Fighting Infection Before the First Incision

Fri, 08/11/2006 - 6:53am
The first line of defense against infection in the human body is the epidermis. Unfortunately, this is generally the first thing that is compromised during a surgical procedure. Whenever the skin is punctured, cut or in any other way pierced, the danger of infection is an inevitable constant. This holds as true in the operating room as anywhere else.

Naturally, if a surgeon is to do his job effectively, if at all, that is a risk he is going to have to take. Fortunately, there are a number of antiseptics that can help manage that risk before the initial incision is even made.

Preoperative patient skin prep products have been in use for nearly a century and, like many other aspects of the surgical field, have been consistently improving. Today there are a number of effective surgical preps to choose from featuring a variety of formulations that can help keep patients safe from surgical site infections.

Medi-Flex’s ChloraPrep® is available in several applicator sizes to meet the specific requirements for surgeries ranging from minor procedures to major operations.
With an over 20 year history of innovative formulation and development of antiseptic skin products, Medi-Flex, Inc., based in Leawood, KS, is no newcomer to the surgical prep market. Their current flagship product, launched in November of 2000, is ChloraPrep®, a two percent chlorhexidine gluconate (CHG) and 70 percent isopropyl alcohol (IPA) patient preoperative skin preparation that meets the FDA’s strict clinical requirement for a New Drug Application. The two percent CHG formulation delivers optimal antiseptic performance, providing maximum antimicrobial protection and avoiding skin irritation.

One application of ChloraPrep exceeds the FDA criteria for a patient’s preoperative skin preparation antiseptic. ChloraPrep acts rapidly against both gram-positive and gram-negative bacteria and is persistent. It prevents the regrowth of microorganisms on the skin for up to 48 hours and even maintains its effectiveness in the presence of blood and organic matter. In addition to its unique formulation, ChloraPrep offers tint technology including Scrub Teal ™ and Hi-Lite Orange™ Tint to help surgeons identify prep margins more easily.

ChloraPrep is available in several applicator sizes (3 mL, 10.5 mL, and 26 mL) designed to meet the specific requirements for surgeries ranging from minor procedures to major operations. While the 26-mL is a new applicator size for ChloraPrep (launched in 2005), the efficacy of the skin prep’s unique formulation has been established through numerous studies surrounding its use for catheter insertion.

ACTIPREP® is a one-step prep solution that allows the user to prep one uniform, thin application. It applies and dries
in less than two
minutes.
Fort Worth, TX-based Healthpoint, Ltd. offers a preoperative skin prep that is based on its patented Trizenol® technology, which is an iodine- and CHG-free formulation that boast effectiveness and persistent protection against viruses (HIV and Hepatitis A) and multiple resistant organisms (MRSA, VRE and others). ACTIPREP® Preoperative Patient Skin Prep is a one-step prep solution that allows the user to prep one uniform, thin application and applies and dries in less than two minutes. It features a film-former that was added to help provide a tacky surface for drapes to adhere to and is tinted orange so as to provide a better contrast with the patient’s skin. ACTIPREP’s thick formula minimizes running and pooling, but can be removed with soap and water, eliminating the need to stock remover lotions.

Healthpoint also offers a full line of other hand and body antiseptics that can be used by surgeons and patients prior to surgery. This product line includes the TRISEPTIN® Hand and Body Antiseptic. Showering with TRISEPTIN twice within 24 hours of surgery significantly reduces the number of microorganisms on the surface of the skin that can cause surgical site infections.

As Healthpoint’s prep products are iodine-free and CHG-free, they are not irritating and will generally not cause a rash or reaction. Additionally, they contain emollients to maintain the skin’s condition.

Headquartered in St. Paul, MN, 3M Health Care provides the surgical market with two preoperative patient skin preparations. The 3M™ DuraPrep™ Surgical Solution is an IPA-based, one-step solution delivered in a self-contained applicator. It combines two proven broad-spectrum antimicrobials: alcohol for fast kill and fast drying (three minutes on the skin), and an iodophor for persistence that dries to a water-insoluble film. This unique film-forming property helps the dried DuraPrep solution to enhance drape adhesion, optimize the persistent effects of iodine and resist wash-off.

3M™ One-Step Patient Prep is the only self-contained, non-alcohol-based, povidone iodine solution delivered in a ready-to-use sterile applicator.
3M Health Care also offers the One-Step Patient Prep, a non-alcohol-based product that can be used on both skin and mucosal tissue (except the eye). One-Step Prep is a self-contained, povidone iodine solution delivered in a ready-to-use sterile applicator. The patented film-forming solution provides the efficacy of a five minute scrub followed by a paint in a two minute application and resists wash-off even after encountering blood or saline. When allowed to dry One-Step Patient Prep enhances drape adhesion in simulated surgical conditions compared to aqueous based preps, and provides persistent activity for up to 24 hours on dry intact skin.

Both 3M™ DuraPrep™ Surgical Solution and 3M™ One-Step Patient Prep have been granted formulation and applicator patents and have low potential for irritation. Both formulations also provide resistance to removal from irrigation and blood while maintaining antimicrobial activity. They demonstrate bactericidal activity against gram-positive and gram-negative bacteria including antibiotic-resistant strains such as MRSA, MRSE, VRE and yeast in vitro.

Care-Tech Laboratories, Inc., based in St. Louis, MO has been a global leader in Over-the-Counter pharmaceuticals for the treatment and prevention of topical infections for 111 years. Designed specifically for use in preoperative procedures, Care-Tech’s TECHNI-CARE® Antiseptic Prep is the only non-toxic, pH balanced, non-alcohol containing prep formulation currently available. TECHNI-CARE is a patented technology and performs as a therapeutic antiseptic as well as an extremely efficient cleansing agent. This product is a synergistic blend of active ingredients, high grade surfactants, emollients, collagen and an exotic phospholipid. The phospholipid is a skin conditioning agent which closely resembles the natural lipids of the skin, eliminating a free radical response to this formulation. The skin cells readily accept this product instead of curling to avoid contact with the antiseptic. It exhibits a biomemetic relationship with the dermis.

Essentially, the entire TECHNI-CARE formulation’s properties are exclusive to its patent, making it a very unique product. It has proven efficacy within 30 seconds on gram negative, gram positive, yeast and fungi. And, as an added bonus, it has also passed the TB test, which is number 1 on the chart as the most difficult organism to kill. TECHNI-CARE has proven efficacy at 24 hours after application on occluded sites in the cup-scrub test conducted as outlined in the Antiseptic Monograph.

Designed specifically for use in preoperative procedures, Care-Tech Laboratories’ TECHNI-CARE® Antiseptic Prep (above & below) is the only non-toxic, pH-balanced, non-alcohol containing prep formulation currently available.
TECHNI-CARE is the only antiseptic which has passed ocular irritation testing and safety for mucous membranes. It is non-toxic by oral ingestion and its dermal irritation test results were very close to saline solution. Allergic reactions have been very rare since its market introduction 11 years ago. McGaw Park, IL-based Cardinal Health offers a full line of one-step preps and skin prep trays, including both iodine and CHG-based products. The entire product line has been rigorously tested to be safe and effective per the FDA’s Tentative Final Monograph. Additionally, all of their CHG products have received FDA approval.

Cardinal’s preoperative skin prep, Prevail®, offers a unique gel solution that allows excellent control over running and pooling of solution. It is also totally water soluble making product removal very easy post-surgery. The Prevail-Fx® skin prep boasts the highest log reductions available. It also has a dark color that can easily be seen on different skin tones. It is water resistant and therefore will not wash-off during fluid intensive procedures, yet comes off using soap and water postoperatively.

Cardinal’s newest offering, the Prevail-STX™ One-Step Patient Preoperative Prep, is a one-step prep that offers a fast, safe and cost-effective solution for surgical procedures. The topical, film-forming prep provides excellent drape adhesion and water insolubility to help ensure a sterile surface throughout surgery. It achieves a 99.9999 percent kill against more than 50 organisms including MRSA, E-coli and Haemophilus influenzae. Prevail-STX features a patented flow-control applicator that allows the clinician to control the amount of solution used and has a plastic applicator instead of a glass ampoule for greater safety. Each applicator contains 40 mL of solution, offering an impressive coverage area and often resulting in fewer applications being used.

All of the Cardinal one-step products offer a high volume of solution (Prevail – 59mL, Prevail-Fx – 40mL, Prevail-STX – 40mL) and plastic/foil applicator design. The large volume of solution provides a great deal of convenience and savings particularly in large volume cases, as fewer applicators are required. Additionally, the applicators do not contain glass, so sharps disposal is not required.

It is easy to see that there are a number of different preoperative patient skin preps available, in a varied assortment of formulations. Each product boasts an impressive list of properties including increasingly impressive kill ratios, persistence timeframes and drying times. And each one of the surgical preps can help the surgical staff protect patients from surgical site infections. The important part for each surgical facility is to discover which patient skin prep product is best for them.

There are a few important areas to look at when choosing a surgical prep. First and foremost, be sure to check for AORN, CDC and FDA compliance. This information is usually included in any product literature provided by the companies supplying surgical prep products, and they are more than willing to pass that information on to interested facilities.

Beyond the initial compliance question, though, there are other factors that hospitals and surgical centers should take into account when investigating the right prep products for their patients. Before deciding, each facility should look into its own standard operating procedures and ask a few questions. Are the gloves and drapes they are using compatible with the patient prep formulation? How will the prep product perform in wet/dry operations? Will the patients have an adverse reaction to the formula? How quick and easy is the application process?

While looking into these aspects of the regular operations of the hospital may not guarantee a 100 percent incident free preoperative prep procedure every time, it can help to cut down on foreseeable problems and bring the right prep for the right patient into the OR at the right time.
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