Preparing To Succeed: The Importance Of Strong Patient Prep Protocols

There are many critical phases in any surgical procedure, and each one requires diligence. Keeping patients safe must be the central goal from the very beginning of their experience, as healthcare staff does the work to prep them for surgery.

Establishing strong protocols in this portion of the healthcare journey is a task that can be overlooked, but it can make the difference between a successful procedure and one bedeviled by complications.

To learn more, Surgical Products interviewed Kimberley S. Prinsen, RN, MSN, technical service specialist with 3M’s infection prevention division.

How important is it for healthcare facilities to establish specific protocols around patient prep?

Protocols help remove variation in practice. In general, variation in practice can mean variation in outcomes, whereas standardization in practice can standardize outcomes. The main purpose of standardizing on specific protocols is to ensure safety and welfare of patients and staff.

Research has shown that variation in processes of care is problematic because it can lead to increased rates of error and potential negative patient outcomes. Establishing protocols for staff to follow around patient prep aligns with best practices to ensure patients receive consistent, high-quality care.

What methods should healthcare facilities use in developing their patient prep protocols?

Methods that employ elimination of variation in process is the foundation of quality improvement and reliability. We first saw these methods in manufacturing in the 1930s. In the 1990s, these methodologies were adapted for the healthcare environment.

Establishing prep protocols that limit the number of variabilities can play a part in reducing the risk of a surgical site infection.

Preoperative Surgical Skin Antisepsis is a critical step in managing the risk of surgical site infection.

What are the best strategies for introducing new patient prep protocols to staff?

Step 1: Decide on the surgical skin preps to be used by the facility. It should be a collaborative effort among surgical services, infection prevention professionals and surgeons. We know that no one prep can meet all the prepping needs because of patient and procedure variability. However, the prep or product choices can be limited to aid in standardization and subsequent training. 

Step 2: Educate and train regarding the appropriate prep selection and application of the surgical prep. This is essential as it ensures the patient benefits from the full efficacy of the product.

Step 3: Assess staff competency initially and annually, or as dictated by the facility’s auditing process.

Is it important for everyone to understand the full protocol, or do individual staff members only need to know their specific responsibilities?

Anyone who applies the surgical prep to the patient should have a full understanding of the protocol and any product that is used for prepping in the facility. The training for those individuals should include:
•           Antiseptic prep selection: Clinicians should ask themselves, “Which prep should I use for each individual patient?” Basic considerations include: patient concerns – age, allergies/sensitivities, type of procedure, intact skin vs open wound.
•           Application method:  Once a prep is chosen, clinicians should determine the correct application method, such as scrub and paint, paint only and back and forth. They should also be done in a way to avoid dripping and pooling. The amount of time the prep needs to be in contact with the skin is also critically important in order for the prep to achieve efficacy.
•           Dry time compliance: If a prep contains alcohol there are dry time guidelines to ensure patient safety and reduce risk of fire/irritation.

Varying from manufacturer’s instructions can impact the efficacy of the preoperative surgical antiseptic and could impact the risk of surgical site infection

New protocols are often followed strictly shortly after introduction, but then with less rigor as time goes on. Are there ways to assure continued adherence to patient prep protocols?

I firmly believe if staff fully understand the purpose of the prep and the rationale for the protocol, then the compliance will follow. However, complacency can occur, so it is important that ongoing assessment of staff and their competency for prep selection and application is built into an auditing or monitoring plan for each surgery department.

Another option is to utilize a “check-up” or observation and assessment program service provided by clinical experts that work in the healthcare industry. The 3M Infection Prevention Division offers this service in conjunction with an educational program that teaches proper surgical skin prepping protocols.

Sometimes a set of eyes that are new to the environment can help identify both strengths and opportunities for improvement related to the prepping process.

What measurable improvements should healthcare facilities expect to see with the adoption of strong patient prep protocols?

Surgical skin prep is one of the foundational steps to preparing the patient for surgery. It alone may not be the only step that impacts outcomes.

Clinicians might expect to see a measurable outcome, however, when implementing a combination of standardized, evidence-based practices related to preparing the surgical patient, such as microbial reduction (pre-op bathing, nasal decontamination), hand hygiene, maintaining normothermia, proper hair removal methods, surgical skin prepping, and sterile surface preparation.

The more a facility can do to ensure the foundation of care is strong and consistent, the better their overall patient outcomes should be. This may be reflected in a decrease in complication rate or reduction in surgical site infections, increase in patient and staff satisfaction scores, cost savings, and reimbursement controls.