Although healthcare professionals rank guidelines as a key consideration for selecting products for skin antisepsis, many don't necessarily follow this advice.
Findings from a survey of 1,500 hospital-based health care professionals (HCPs) suggest that 33% report they do not follow evidence-based guidelines and data for patient skin antisepsis.
This result is especially surprising, particularly since the survey showed that HCPs—many 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.
"It’s 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 aren’t being put into practice more frequently," said Allan Morrison, Jr., MD, MSc, professor and distinguished senior fellow at George Mason University in the School of Public Policy, in a statement. "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 survey, which was conducted by Infection Control Today magazine and sponsored by CareFusion, sought to examine 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% 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, according to the survey, which found that 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 HCPs who were not specialists in this area. For example, 77% of infection preventionists said they use CHG products for patient skin antisepsis compared to only about half of other HCPs (53%).
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 HCPs. According to the survey, 56% 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% of other HCPs. Also, more HCPs not specialized in infection prevention reported the use of iodine alone as most commonly used within their institution — 14% vs. 5% 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% CHG and 70% isopropyl alcohol when compared to use of povidone-iodine solution reduced total surgical site infections (SSIs) by 41%.
It has been established that HAIs can be reduced with proper hand antisepsis by healthcare professionals. Recommendations and guidelines, including those from the CDC and the World Health Organization, state that HCPs should clean their hands with an alcohol-based hand-scrub 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% 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.
For more information about the survey, click here.
Do you rank clinical data and guidelines as the most important consideration for selecting a product for skin antisepsis? If so, how closely do you follow these guidelines?
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