Contamination from the patient’s own skin is the #1 cause of surgical site infections.1,2 Take control by implementing a combination of antimicrobial skin prep and iodine-impregnated incise drapes to reduce contamination around the surgical site.3
Surgeries using iodophor/alcohol-based surgical preps, including 3M™ DuraPrep™ Surgical Solution (Iodine Povacrylex [0.7% available iodine] and Isopropyl Alcohol, 74% w/w) Patient Preoperative Skin Preparation, had a significantly lower SSI rate than surgeries using ChloraPrep™ Skin Prep.4
Another study showed:
- DuraPrep Surgical Solution demonstrated resistance to removal by saline-soaked gauze (ρ<.0001).5
- DuraPrep Surgical Solution suppresses regrowth of bacteria for at least 48 hours** with and without a blood and saline challenge.5
Download the clinical evidence summaries if you want more details about how DuraPrep Surgical Solution helps reduce the risk of SSIs and resists wash-off.
In a study published in 2015, Ioban 2 Antimicrobial Incise Drapes were associated with lower SSI risk and reduced cost when compared to a non-antimicrobial incise drape in cardiac surgery.6
Ioban 2 Antimicrobial Incise Drape were:
Download the clinical evidence summaries if you want more details about how Ioban 2 Antimicrobial Incise Drapes kill microbes in the deepest layers of skin and can help reduce the risk of wound infection.
If we can reduce the number of microorganisms on the skin, we can reduce the risk of infection.
*when implant is present
A proper skin prep reduces a patient’s bacterial load throughout the perioperative process, providing both immediate and lasting protection. But not all preps perform the same during surgery. Some preps can be removed during surgery by saline irrigation, dabbing with sponges or gauze, or contact with bodily fluids.
If surgical prep is removed during surgery, patients may lose the critical protection of the active ingredient.
3M™ DuraPrep™ Surgical Solution (Iodine Povacrylex [0.7% available iodine] and Isopropyl Alcohol, 74% w/w) Patient Preoperative Skin Preparation was formulated with 3M™ Prep Protection Film, which dries to form a persistent and durable layer of protection on the patient’s skin to protect the prep from removal during surgery.10
While skin prep antiseptics reduce microbes, they do not eliminate all skin flora. An incise drape creates a physical barrier to prevent objects like instruments, gloves and sponges from coming into contact with the patient’s skin and transporting residual skin microbes to the surgical incision, which could result in a costly and potentially devastating SSI. Iodine-impregnated antimicrobial drapes not only immobilize residual microbes but kill microbes that migrate to the skin’s surface from the deeper skin layers and hair follicles.11,12
In a study published in 2015, 3M™ Ioban™ 2 Antimicrobial Incise Drape was associated with lower SSI risk and reduced cost when compared to a non-antimicrobial incise drape in cardiac surgery.13
In addition, a recent ex vivo study on human skin showed the iodine in Ioban 2 Antimicrobial Incise Drape was present at concentrations effective against MRSA at a depth of 1,000 microns, in the deeper layers of the skin, where hair follicles are present.12
Truth: There are no FDA-approved surgical preps with sterile solution available in the U.S., however, many users believe that surgical preps are sterile. When you see the words “Sterile applicator,” only the applicator is sterile; the solution itself – whether it contains alcohol, iodine, and/or CHG –- is not. APIC states "all skin preparation products should be manufactured to be sterile. While we are aware that research and work needs to be done to enable the production of sterile prep agents, APIC believes the time has come to begin those processes to provide sterile prep products."*
*APIC Comments to FDA on Antiseptic Patient Preoperative Skin Preparation Products Docket No. FDA-2012-N-1040. (APIC response letter dated Feb. 6, 2013). http://www.apic.org/Advocacy/Advocacy-Updates/Detail?id=45beeb3b-d668-4153-a13f-c05c1a266046
Truth: Most preps are water soluble, which means they can be removed from the skin during surgery by challenges like irrigation, wiping, bodily fluids, etc. A surgical prep needs to stay on the skin to actually be effective. The 3M™ Prep Protection Film in 3M™ DuraPrep™ Surgical Solution forms a persistent and durable layer of protection, helping the prep stay on the patient’s skin. And when we say 48 hours, we mean at least 48 hours* of antimicrobial persistence with and without a blood and saline challenge**,+. Can your prep say the same?
*after simulated surgical conditions. ** 3M Study-05-010565. +Stahl JB, Morse D, Parks PJ. Resistance of antimicrobial skin preparations to saline rinse using a seeded bacteria model. Am J Infect Control. 2007;35:367-73.
Truth: There is no one surgical prep solution suitable for all surgeries—whether containing iodine, alcohol, CHG or a combination of these. Patient considerations and prep contraindications must be considered when selecting the proper prep; make sure your staff is well educated on relevant standards and surgical prep selection criteria.
Truth: A proper surgical skin prep reduces a patient’s bacterial load throughout the perioperative process, providing both immediate and lasting protection. Vascular prep application happens in a controlled environment with essentially no “challenge” to the staying power of the prep: the skin is prepped, a line inserted, and the site is covered and protected. In contrast, the surgical site is rife with challenges and clearly DOES NOT remain untouched after initial application of the prep. In surgery, the surgical site is irrigated with saline, dabbed and wiped with wet sponges and gauze, and touched and manipulated throughout the procedure. A surgical prep needs to remain on the skin—despite all these challenges—for sustained antimicrobial activity.
Truth: A surgical prep doesn’t just work in the operating room; if surgical prep is left on the skin, it can continue to provide antimicrobial protection as the wound seals, which typically happens within 24-96 hours following the completion of surgery. 3M™ Prep Protection Film, a component of 3M™ DuraPrep™ Surgical Solution, helps the active ingredient stay on the skin throughout surgery—even when subjected to surgical challenges like blood and saline—and beyond to maintain antimicrobial activity. DuraPrep Surgical Solution provides at least 48 hours of antimicrobial persistence.* When we say 48 hours, we mean at least 48 hours persistence antimicrobial activity with and without a blood and saline challenge.
*3M Study 05-010565.
Truth: Antimicrobial incise drapes have been associated with reduced risk of surgical site infection,*+ and protect the skin — up to the wound edge — with both a physical barrier and antimicrobial protection. However, for an incise drape to be effective, it has to stick to the skin, and some surgical prep formulations attract moisture which can interfere with adhesion, causing the incise drape to lift at the wound edge.
3M scientists developed 3M™ Prep Protection Film to help surgical preps stay on the skin while also acting as a primer, helping incise drapes adhere well to the skin to minimize lifting, especially at the wound edge. In one study, 3M™ DuraPrep™ Surgical Solution with 3M™ Prep Protection Film was used in combination with 3M™ Ioban™ 2 Antimicrobial Incise Drape, and no cases of incise drape lift were observed, while ChloraPrep™ Skin Prep used with the Ioban 2 incise drape resulted in lift of the incise drape in 25% of cases.*
*Alexander JW, Aerni S, Plettner JP. Development of a safe and effective one-minute preoperative skin preparations. Arch Surg. 1985;120:1357-1361.
+Data on file 3M Study EM-05-013561, 3M Health Care.
Truth: Many preps, due to low viscosity, are more prone to dripping and pooling around the patient, which can pose potential hazards such as fire and chemical burn risk for patients.
In addition to confirming you are using proper prepping technique, there are choices of surgical preps that have a higher viscosity and therefore are less likely to drip. 3M™ Prep Protection Film, a component of surgical preps such as 3M™ DuraPrep™ Surgical Solution, is a technology designed to increase the “thickness” of the solution. That means less dripping and pooling.
Truth: Depending on skin tone, it can be difficult to see where surgical prep has been applied. Darker skin tones mask the tint of some surgical preps. For example, preps that are tinted orange can be harder to see during and after application.* This may lead to gaps in prep coverage, leaving islands of bacteria that can make their way into the surgical wound, increasing the risk of an SSI.
*McDaniel, Claire M., Churchill, Ryan W., Argintar, Evan. Visibility of Tinted Chlorhexidine Gluconate Skin Preparation on Varied Skin Pigmentations. Orthopedics. 2017;40(1):e44-e48.
Truth: Surgical preps primarily work on the surface of the skin and do not kill all bacteria. You can do more to protect your patients by going beyond a prep—add an antimicrobial incise drape. In an ex vivo study using 3M™ Ioban™ 2 Antimicrobial Incise Drapes, iodine was shown to be present in the deeper layers of the skin at concentrations effective against methicillin-resistant Staphylococcus aureus (MRSA).* Hair follicles are present in these deeper skin layers and contain bacteria which may cause infection.
*Casey AL, Karpanen TJ, Nightingale P, Conway BR, Elliott TSJ. Antimicrobial activity and skin permeation of iodine present in an iodine-impregnated surgical incise drape. J Antimicrob Chemother. 2015; 70: 2255-60.
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2. Cheadle WG. Risk factors for surgical site infection. Surg Infect. 2006;7(s1):s7-s11.
3. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999; 20:247-78.
4. Swenson BR, Hedrick, TL, Metzger R, Bonatti H, Pruett TL, Sawyer RG. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infect Control Hosp Epidemiol. 2009;30:964-71.
5. Stahl JB, Morse D, Parks PJ. Resistance of antimicrobial skin preparations to saline rinse using a seeded bacteria model. Am J Infect Control. 2007;35:367-73.
6. Bejko J, Tarsia V, Carrozzini M, et al. Comparison of efficacy and cost of iodine impregnated drape vs. standard drape in cardiac surgery: study in 5100 patients. J Cardiovasc Transl Res. 2015;8:431-7.
7. Human Microbiome: FAQ. American Society for Microbiology Academy Web site. https://www.asm.org/images/stories/documents/FAQ_Human_Microbiome.pdf. (PDF, 4.45 MB) 2013. Accessed March 23, 2017.
8. Percival SL, Emanuel C, Cutting KF, Williams DW. Microbiology of the skin and the role of biofilms in infection. Int Wound J. 2012;9:14-32.
9. Feldman G, Fertala A, Freeman T, et al. Recent advances in the basic sciences: osteoarthritis, infection, degenerative disc disease, tendon repair and inherited skeletal diseases. In: Austin MS, Klein GR, ed. Recent Advances in Orthopedics. 1st ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2014:256.
10. Roberts AJ, Wilcox K, Devineni R, Harris RB, Osevala MA. Skin preparations in CABG surgery: a prospective randomized trial. Comp Surg. 1995;14:724, 741-7.
11. French MLV, Eitzen HE, Ritter MA. The plastic surgical adhesive drape: an evaluation of its efficacy as a microbial barrier. Ann Surg. 1976; 184: 46-50.
12. Casey AL, Karpanen TJ, Nightingale P, Conway BR, Elliott TSJ. Antimicrobial activity and skin permeation of iodine present in an iodine-impregnated surgical incise drape. J Antimicrob Chemother. 2015;70:2255-60.
13. Bejko J, Tarzia V, Carrozzini M, et al. Comparison of efficacy and cost of iodine impregnated drape vs. standard drape in cardiac surgery: Study in 5100 patients. J Cardiovasc Trans Res. 2015;8:431-7.
14. Eyberg CE, Morse DJ, Olson LK, Parks PJ. An in vitro time-kill study to compare the antimicrobial activity of three antimicrobial surgical incise drapes. Poster presented at; 19th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (SHEA); March 2009; San Diego, CA.
**following ASTM E1173
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