Prep

Prep Solutions

I have no financial stake in companies that produce below products. The products below are for surgical prep. What that means is they are made to clean the skin to prevent bacterial invasion. So, a good prep will remove bacteria currently on the skin and will prevent bacterial invasion during the surgical procedure. The surgical procedure can sometimes involve saline irrigation which could either remove some of the prep or cause some of the prep to wash into the surgical wound. Therefore a good prep will also avoid these situations.

In general:

Chloraprep

Application: scrub (30 seconds if dry site, 2 min if moist site)

Dry time: 3 minutes on hairless surface

Duration of coverage: 48 hours

Antiseptic ingredient: alcohol chlorhexidine gluconate (denatures protein, disrupts cell membranes)

Duraprep

Application: paint

Dry time: 3 minutes on hairless surface

Duration of coverage: 48 hours

Antiseptic ingredient: alcohol iodophor (denatures protein, and free iodine causes DNA damage)

Betadine

Application: Multistep process of scrub followed by paint

Dry time: happens when it happens (I didn’t see an official number on product website)

Duration of coverage: 2 hours

Antiseptic ingredient: aqueous-iodophor (free iodine causes DNA damage)

Above info from (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809986/)

Duraprep:

Dura prep comes in a “prep stick” that we apply to the surgical area exposed during draping. It is a liquid whose primary antiseptic agent is iodine povacrylex (IPA, not the beer). From an advertisement side the products is marketed as providing “both rapid bacterial kill and long lasting antimicrobial persistence.” The persistence comes in the form of a film that is left once the solution dries on the skin. The film also acts as a primer that allows incise drape to stick to the skin better.

Caveats:

Large applicator (8630) meant for large prep areas below the neck (I shouldn’t use these for brain cases, but I guess I can still use them on spine cases). The website evens says “do not use the 26mL applicator for head and neck surgeries.”

Pearls?

Minimum of 3 minutes dry time on hairless skin, but 1 HOUR?!??!! in hair (moral of story, clip the hair, I guess Ioban doesn’t stick well to hair either so it kind of helps). Wet solution is flammable.

You do not need to scrub with the applicator, but instead paint in a uniform area. So I guess if I’m concerned about gross contamination or poor hygiene, I should scrub the area of interest and let dry prior to application of duraprep.

Water insoluble so the solution/film once dried will be resistant to removal from irrigation or blood that may be encountered during the surgery. I guess this also means after surgery if trying to remove, then irrigation won’t be helpful.

NOT appropriate for open wounds (lacerations, GSW, decubitus ulcers).

Do not use on patients with iodine allergies

Solution can kill bacteria for at least 48 hours after exposure to blood and saline (maybe I shouldn’t remove the film after surgery)

Betadine

Trade name for povidone iodine. Contains complex iodine and release free iodine which is bactericidal component. Water soluble means that it can be washed away during irrigation or possible if blood gets on the area. Application instructions according to the website include wet skin with water, apply scrub to develop a lather and scrub thoroughly for 5 minutes and rinse off using sterile gauze saturated with water, followed by paint with betadine solution and allow to dry. No official dry time cited.

(https://betadine.com/medical-professionals/betadine-surgical-scrub/)

Pearls?

Trying to place an ioban over betadine that is not fully dry does not end well. Either be patient or apply sterile dry towel to absorb excess fluid.

Chloraprep

Application instructions are for 30 seconds on dry sites and for 2 minutes on moist sites (axilla, inguinal fold). Allow a dry time of 3 minutes on hairless skin and up to 1 hour in hair. Instructions also say not to blot or wipe away solution.

Specifically instructions say not to use for lumbar puncture or in contact with meninges. I guess this means no brain or spine procedures. So pretty much don’t use for neurosurgery?

(https://www.bd.com/en-us/offerings/brands/chloraprep)

Chlorhexidine

Use applicator to scrub the area of interest while applying solution. In terms of preventing surgical site infections, a study by Darouiche et al demonstrated preoperative cleansing with chlorhexidine-alcohol solution superior to povidone-iodine for preventing surgical site infection after clean-contaminated surgery (https://www.nejm.org/doi/full/10.1056/nejmoa0810988).