Allergic to scrub soap?

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wannabeOBGYN

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Has anybody had any problems with the soap used to scrub into the OR? I'm having a pretty bad reaction on my arms and nobody seems to have any suggestions as to what I should do. I'm not asking for treatments (I already spoke with my own doctor), but rather for advice on which soaps seem to be the least allergenic in people's experience. I've heard the iodine-based soaps can be pretty rough on your skin and I wasn't even using that, so I'm kind of at a dead end here. Any thoughts or personal experiences people could share would be appreciated. Thanks!

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Has anybody had any problems with the soap used to scrub into the OR? I'm having a pretty bad reaction on my arms and nobody seems to have any suggestions as to what I should do. I'm not asking for treatments (I already spoke with my own doctor), but rather for advice on which soaps seem to be the least allergenic in people's experience. I've heard the iodine-based soaps can be pretty rough on your skin and I wasn't even using that, so I'm kind of at a dead end here. Any thoughts or personal experiences people could share would be appreciated. Thanks!

Allergic or sensitive?

If you're allergic to the CHG scrubs, you can certainly try the iodine-based ones. If you're just sensitive (like a chemical sensitivity) or just getting dried out and cracked skin from CHG+scrubbing you're going to be stuck with just trying to keep them well moistened and hope for the best.
 
Yes, it is possible to be allergic to these. You can try the betadine scrub if you want (some--certainly not most--people don't find it as bad on their skin as CHG, although it can be drying and/or cause itching.). You can always wash your arms (with regular soap/water/whatever) after you are done with a case to get rid of any residual soap on your arms and see if that helps, too.

Do you have the option for the no-scrub scrubs like Avagard or other alcohol based formulas? You may not react as much to those, although they can be drying to the skin.
 
Make sure to try to both the chg w/ and w/o emollients, one may work for you.
 
Thanks for the responses! I honestly never looked that closely at the scrub soaps, I just knew there were iodine soaps and something else. I'm on clinic this week and therefore not scrubbing, but I will be sure to look closely at everything when I go back to the OR next week.

Smurfette- regarding the no-scrub scrubs, I haven't had a problem to date, but I've always been under the impression that we could only use those after an initial full scrub at the start of the day. Is that not true?
 
I had the impression you were reacting from repeatedly scrubbing with the standard scrubs. Just pay attention to what the options are at your hospital and try all of them....find what works for you.

You are supposed to do a full scrub to get dirt out from under your nails and stuff.

Some people I know will scrub with one of the standard agents, then will immediately wash with regular soap/water (maybe with a moisturizer) to get the scrub agent off their skin before then using the alcohol based stuff for the first case of the day. This way, they have done the mechanical cleansing they recommend. Depending on what kind of reaction you have, this may minimize time of contact on your skin and decrease your skin reaction. Worth a shot. Works with betadine scrub, at least.

If you really react badly and have no alternatives, you probably can wash with other soap and water, clean under your nails, etc., dry off, and then use the no-scrub stuff. The no-scrub reps IIRC will tell you that studies have shown this to also be effective, but it's not the official recommendation for OR use. One of my old-school attendings did this due to developing bad reactions to scrub soaps after 35 years of surgery. As a student, though, I wouldn't do this unless you get the ok from someone; you'd probably need a medical note from your derm or something to get this accommodation from your clerkship director.
 
Thanks for the responses! I honestly never looked that closely at the scrub soaps, I just knew there were iodine soaps and something else. I'm on clinic this week and therefore not scrubbing, but I will be sure to look closely at everything when I go back to the OR next week.

If you thought you had an allergy, why wouldn't you systematically try each soap to see what's causing the problem? Rule each one in or out.

For scrub soaps that come with the actual scrub sponge, it's usually going to be a choice between chlorhexidine gluconate (CHG) or Betadine (iodine). Then there are those non-scrub soaps (like Avagard). Also test to make sure it's not the vinyl or latex gloves that are giving you problems.
 
Out of curiosity, why is such a rigorous scrubbing still required/recommended despite the fact that nothing is done without sterile gloves/gown anyhow?
 
Out of curiosity, why is such a rigorous scrubbing still required/recommended despite the fact that nothing is done without sterile gloves/gown anyhow?

Tears, punctures, and micro-perforations happen (pdf). Someone who didn't do a surgical scrub before gowning/gloving could be seeding someone else's thoracic cavity / abdominal cavity / whatever else with whatever nastiness they're carrying with them.
 
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