Survey Shows One-Third of HCWs Don't Follow Evidence-Based Guidelines for Skin Antisepsis

A survey released today of 1,500 hospital-based healthcare professionals reveals that 33 percent report they do not follow evidence-based guidelines and data for patient skin antisepsis.

This finding is especially surprising given that the survey, which was conducted by Infection Control Today magazine and sponsored by CareFusion, shows healthcare professionalsmany of whom are responsible for infection prevention at their facilities rank clinical data and guidelines as the most important consideration for selecting a product for skin antisepsis.

"Its promising to see healthcare professionals recognize the importance of following established recommendations and guidelines for reducing healthcare-associated infections (HAIs), but it is disappointing that these guidelines arent being put into practice more frequently," says Allan Morrison, Jr., MD, MSc, FACP, FIDSA, professor and distinguished senior fellow at George Mason University in the School of Public Policy. "Given that microorganisms on patients skin are a primary cause of HAIs, skin antisepsis should be a top priority for institutions. Additionally, adherence to clinical guidelines by all healthcare professionals regardless of specialty or tenure is critical. Fortunately, skin antisepsis measures are relatively inexpensive and easy to implement."

The study examined practices and perceptions of hospital-based healthcare workers with regard to use of chlorhexidine gluconate (CHG) skin antisepsis. Numerous published studies support the use of 2 percent CHG and CHG-based formulations for patient preoperative skin preparation to help reduce bacteria that can cause skin infections.

Length of time in clinical practice was a major determinant for how important vigilance with skin antisepsis was perceived for reducing infections. Those with less than 20 years in practice ranked skin antisepsis as higher in importance for reducing infections compared to those with 20 or more years of experience.

The survey also revealed significant differences between the practices of infection preventionists versus. health care professionals who were not specialists in this area. For example, 77 percent of infection preventionists said they use CHG products for patient skin antisepsis compared to only about half of other healthcare professionals (53 percent).

A more startling difference was found in the reported use of a combination of CHG and alcohol for patient skin antisepsis by infection preventionists compared to other healthcare professionals. According to the survey, 56 percent of infection preventionists cited a combination of CHG and alcohol as most commonly used for patient skin antisepsis at their institution, compared to just 36 percent of healthcare professionals who were not infection preventionists. Also, more healthcare professionals not specialized in infection prevention reported the use of iodine alone as most commonly used within their institution 14 percent vs. 5 percent of infection preventionists. This difference signals a gap between the reported importance of data and guidelines compared to implementation in clinical practice. For example, data published this year in The New England Journal of Medicine demonstrate that use of 2 percent CHG and 70 percent isopropyl alcohol when compared to use of povidone-iodine solution reduced total surgical site infections (SSIs) by 41 percent, (16.1 percent vs. 9.5 percent).

HAIs are a major public health concern in the United States. Patients who develop HAIs have longer hospital stays, use more healthcare resources, such as IV antibiotics and clinician care, and are at greater risk for readmission and death.

It has been established that HAIs can be reduced with proper hand antisepsis by healthcare professionals. Recommendations and guidelines, including those from the Centers for Disease Control and Prevention (CDC) and the World Health Organization, state that health care professionals should clean their hands with an alcohol-based hand-scrub (such as Surgicept - 70% Ethyl alcohol), prior to patient contact or putting on gloves. Interestingly, the survey results revealed that healthcare workers perceive hand hygiene as the most important factor in reducing the risk of infection following any in-patient medical procedure.

For preoperative patient skin antisepsis, a clinically proven 2 percent CHG formulation is a key component. CHG is recommended for patient skin antisepsis by at least 18 organizations and initiatives, including the CDC and the National Institutes of Health, with 10 organizations specifically advocating for the use of a 2 percent CHG formulation, such as ChloraPrep® patient preoperative skin prep (2 percent chlorhexidine gluconate and 70 percent isopropyl alcohol).

The survey, conducted Sept. 15-29, 2010 by Infection Control Today magazine and supported by CareFusion, was designed to understand the practices and perceptions of hospital-based health care workers with regard to use of skin antisepsis. In total, 15,000 surveys were sent, resulting in a 10 percent response rate. Survey respondents included infection preventionists, epidemiologists, hospital administrators or materials managers, staff nurses and other healthcare workers.

ChloraPrep patient preoperative skin preparation a combination of 2 percent chlorhexidine gluconate and 70 percent isopropyl alcohol is a proven antiseptic designed to prepare patients skin for a broad range of major and minor surgical procedures by reducing the number of microorganisms on the skin. The ChloraPrep patient preoperative skin prep formulation helps in two ways: Isopropyl alcohol rapidly kills microorganisms while chlorhexidine maintains persistent antimicrobial activity. Further, the applicators soft sponge gently scrubs the skin to help the solution penetrate the first five layers of the epidermis, where 80 percent of microorganisms reside. The applicator minimizes direct hand-to-patient contact, helping reduce the risk of cross-contamination.