Chloraprep vs betadine

[lobelsteve]

Do you all alcohol swab single dose vials? There's a SIS fact finder that recommends with weak evidence, but never did in training and not routine at several facilities I've been to.

CDC recommends it. DOn't do it and someone gets infected, screwed like above.

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[deleted875186]

Expert Witness Case #23

What other physicians are saying about The Expert Witness Newsletter: "Reading your material has definitely shaped my documentation & my approach to the undifferentiated patient." - Dr. Emily Hamburg-Shields A 65-year-old man presented to a pain management clinic for low back pain. He was seen...

expertwitness.substack.com

“
A 65-year-old man presented to a pain management clinic for low back pain. He was seen by Dr. F, who is a board certified anesthesiologist and pain management physician. He underwent an uneventful lumbar epidural steroid injection. Four days later he developed fever, weakness and confusion. He was found to have a brain abscess and severe hydrocephalus. He was transferred to an academic medical center, where an EVD was placed with frank purulent discharge. He died several days later.

A lawsuit was filed alleging that the physician was negligent in his antiseptic technique. He had used Betadine, and the plaintiffs felt that Chlorhexidine should have been used instead.”

Well s**t, now I’m thinking betadine is the worst….

I guess my only solution is to prep with betadine, wipe off with alcohol, and then give it the old chlorhexidine.

 

[geauxg8rs]

Well s**t, now I’m thinking betadine is the worst….

I guess my only solution is to prep with betadine, wipe off with alcohol, and then give it the old chlorhexidine.

And then send them home with broad spectrum Antibiotics and a script for a bubble to live in

 

[geauxg8rs]

Well s**t, now I’m thinking betadine is the worst….

I guess my only solution is to prep with betadine, wipe off with alcohol, and then give it the old chlorhexidine.

That expert witness newsletter looks interesting. Thanks for sharing, going to subscribe

 

[Agast]

That expert witness newsletter looks interesting. Thanks for sharing, going to subscribe

This is a good one esp for anesthesiology background

Case 13: Cervical Fusion

 

[cbest]

Would Duraprep be a decent substitute while the Chloraprep back log sorts itself out?

 

[strike5858]

CDC recommends it. DOn't do it and someone gets infected, screwed like above.

So in your procedure note are you documenting that you clean the single dose vial prior to drawing up the medication?

I have no experience with the medicolegal side but obviously I want to make sure I do everything to make sure my documentation is bullet proof, but how far do you go?

I always have the vials cleaned with alcohol swap prior to drawing meds. I always use chloraprep. When I write my note I don’t mention that I cleaned the single dose vial with alcohol. Does that mean some dirt bag attorney is gonna claim since it’s not documented it didn’t happen?

When I write my notes I mention the procedure site was prepped with “our standard antiseptic solution” and draped in sterile fashion. I don’t specifically mention choraprep. But do you recommend I change my notes and specify I used chloraprep?

This stuff really kills me and takes the joy out of medicine honestly. Infections are a known risk but yet the fact that you can still get sued and they can win is quite discouraging.

 

[lobelsteve]

So in your procedure note are you documenting that you clean the single dose vial prior to drawing up the medication?

I have no experience with the medicolegal side but obviously I want to make sure I do everything to make sure my documentation is bullet proof, but how far do you go?

I always have the vials cleaned with alcohol swap prior to drawing meds. I always use chloraprep. When I write my note I don’t mention that I cleaned the single dose vial with alcohol. Does that mean some dirt bag attorney is gonna claim since it’s not documented it didn’t happen?

When I write my notes I mention the procedure site was prepped with “our standard antiseptic solution” and draped in sterile fashion. I don’t specifically mention choraprep. But do you recommend I change my notes and specify I used chloraprep?

This stuff really kills me and takes the joy out of medicine honestly. Infections are a known risk but yet the fact that you can still get sued and they can win is quite discouraging.

I do not document those things. Maybe I should. My procedure notes are templated so it is just inserting a line into the template.

I think it comes into question at deposition. I have seen staff deposed and asked these questions.

 

[RoloTomassi]

Yeah I think I might add. Should add that you wore a mask too. Depo will be chance to explain but should go by the rule that not documented = not done.

 

[Ronin1]

This is a good one esp for anesthesiology background

Case 13: Cervical Fusion

Straight up clean kill. Write the check

 

[ctts]

In regards to the hibiclens/chlorhexidine and isopropyl alcohol mix...instead of mixing, I would think would also be ok to prep with the hibiclens first, then prep with alcohol, without mixing the two solutions first?

 

[pastafan]

In regards to the hibiclens/chlorhexidine and isopropyl alcohol mix...instead of mixing, I would think would also be ok to prep with the hibiclens first, then prep with alcohol, without mixing the two solutions first?

My practice chlorhexidine then alcohol X 3.

 

[buddababa]

My practice chlorhexidine then alcohol X 3.

seems like overkill no?

even for surgery, 99% of the time is just chloraprep then drape.

 

[pastafan]

seems like overkill no?

even for surgery, 99% of the time is just chloraprep then drape.

Nothing succeeds like excess. Definitely overkill but I went 30 years without an infection from injections. I also think chloroprep can be irritating to the skin so alcohol had a dual purpose.

 

[painfree23]

My practice chlorhexidine then alcohol X 3.

Do you use vodka or whiskey?

 

[pastafan]

Do you use vodka or whiskey?

Depends on what type of day I had...

 

[bedrock]

Do you all alcohol swab single dose vials? There's a SIS fact finder that recommends with weak evidence, but never did in training and not routine at several facilities I've been to.

It’s overkill if you trust your staff not to touch the vials as they open them up.

 

[lobelsteve]

It’s overkill if you trust your staff not to touch the vials as they open them up.

No its not. Swab before every draw. New or not. It is not a sterile cap.

 

[bedrock]

No its not. Swab before every draw. New or not. It is not a sterile cap.

Do you have a literature citation for this?

not just an SIS guideline?

 

[lobelsteve]

Do you have a literature citation for this?

not just an SIS guideline?

What is wrong with SIS? If you get infection traced to a contaminated vial, the expert testifying against you will use this:

https://cdn.ymaws.com/www.spineintervention.org/resource/resmgr/factfinder/FactFinder_2019_03_Swabbing_.pdf

But it also lists the references you asked for.

 

[painfree23]

What is wrong with SIS? If you get infection traced to a contaminated vial, the expert testifying against you will use this:

https://cdn.ymaws.com/www.spineintervention.org/resource/resmgr/factfinder/FactFinder_2019_03_Swabbing_.pdf

But it also lists the references you asked for.

Does your procedure note document you do this?

 

[lobelsteve]

Does your procedure note document you do this?

Nope.

Also doesn't document how often the floors are cleaned or that table wiped down between cases.

 

[mid|ine]

Any resources for "standard of care" for injection site prep?
Does Rubbing alcohol meet "standard of care"? x1 or x3?

 

[ziggyziggy]

Expert Witness Case #23

What other physicians are saying about The Expert Witness Newsletter: "Reading your material has definitely shaped my documentation & my approach to the undifferentiated patient." - Dr. Emily Hamburg-Shields A 65-year-old man presented to a pain management clinic for low back pain. He was seen...

expertwitness.substack.com

“
A 65-year-old man presented to a pain management clinic for low back pain. He was seen by Dr. F, who is a board certified anesthesiologist and pain management physician. He underwent an uneventful lumbar epidural steroid injection. Four days later he developed fever, weakness and confusion. He was found to have a brain abscess and severe hydrocephalus. He was transferred to an academic medical center, where an EVD was placed with frank purulent discharge. He died several days later.

A lawsuit was filed alleging that the physician was negligent in his antiseptic technique. He had used Betadine, and the plaintiffs felt that Chlorhexidine should have been used instead.”

It beats me after reading this that "Why do we have betadine in every epidural tray?"

 

[Ducttape]

mostly because the label that says chlorhexidine is not supposed to be used in any procedure that contacts meninges.

so companies selling epidural trays will not include chlorhexidine. at least that was my experience when we started ordering them.

 

[BobBarker]

I would recommend doing the hibiclens and alcohol separately so that the alcohol does not get diluted to below 50%.

Using Prevantics swabs would be preferable. Basically the same as a chloraprep.