Title: Perioperative Skin Preparation
Liaisons: Anthony T Tokarski BS
Leaders: David Blaha MD (US), Michael A. Mont MD (US), Parag Sancheti MS, DNB, MCh (International)
Delegates: Lyssette Cardona MD, MPH, MHA, AAHIVS, FIDSA, Gilberto Lara Cotacio MD, Mark Froimson MD, Bhaveen Kapadia MD, James Kuderna MD, PhD, Juan Carlos López MD, Wadih Y Matar MD, MSc, FRCSC, Joseph McCarthy MD, Rhidian Morgan-Jones MB BCh, FRCS, Michael Patzakis MD, Ran Schwarzkopf MD, Gholam Hossain Shahcheraghi MD, Xifu Shang MD, Petri Virolainen MD, PhD, Montri D. Wongworawat MD, Adolph Yates Jr, MD
Vol 1, Num S1, September 2014
Question 1A: Is there a role for preoperative skin cleansing with an antiseptic?
Consensus: Yes. Preoperative cleansing of the skin with chlorhexidine gluconate (CHG) should be implemented. In the presence of a sensitivity to CHG, or when it is unavailable, it is our consensus that antiseptic soap is appropriate.
Delegate Vote: Agree: 90%, Disagree: 8%, Abstain: 2% (Strong Consensus)
Question 1B: Question 1B: What type and when should preoperative skin cleansing with an antiseptic be implemented?
Consensus: We recommend that whole-body skin cleansing should start at least the night prior to elective arthroplasty. It is a consensus that after bathing patients are advised to sleep in clean garments and bedding without the application of any topical products.
Delegate Vote: Agree: 85%, Disagree: 10%, Abstain: 5% (Strong Consensus)
Question 2: Which agent, if any, is the optimal agent for surgical skin preparation?
Consensus: There is no clear difference between various skin preparation agents. There is some evidence that combinations of antiseptic agents with alcohol may be important for skin antisepsis.
Delegate Vote: Agree: 89%, Disagree: 8%, Abstain: 3% (Strong Consensus)
Question 3A: Question 3A: What is the proper method of hair removal?
Consensus: Clipping, as opposed to shaving, is the preferred method for hair removal. We cannot advise for or against the use of depilatory cream for removal of hair.
Delegate Vote: 92%, Disagree: 3%, Abstain: 5% (Strong Consensus)
Question 3B: When should hair removal be performed?
Consensus:If necessary, hair removal should be performed as close to the time of the surgical procedure as possible.
Delegate Vote: Agree: 94%, Disagree: 4%, Abstain: 2% (Strong Consensus)
Question 4: What special considerations should be given to a patient with skin lesions?
Consensus: Elective arthroplasty should NOT be performed in patients with active ulceration of the skin in the vicinity of the surgical site. It is our consensus that incisions should not be placed through active skin lesions. For certain lesions, such as those due to eczema and psoriasis, surgery should be delayed in these patients until their lesions have been optimized.
Delegate Vote: Agree: 96%, Disagree: 2%, Abstain: 2% (Strong Consensus)
Question 5A: How should the surgeon and assistants wash their hands?
Consensus: The surgeon and operating room personnel should mechanically wash their hands with an antiseptic agent for a minimum of 2 minutes for the first case. A shorter period may be appropriate for subsequent cases.
Delegate Vote: Agree: 71%, Disagree: 24%, Abstain: 5% (Strong Consensus)
Question 5B: With what agent should the surgeon and assistants wash their hands?
Consensus: There is no clear difference among various antiseptic agents for hand washing.
Delegate Vote: Agree: 80%, Disagree: 15%, Abstain: 5% (Strong Consensus)