Chlorhexidine prior to C-section

[acidbase1]

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Is it imperative to wait the 3 minutes to dry before proceeding?

What about in a Stat c section situation? Betadine?

 

[HomeSkool]

Chlorhexidine disinfects while wet; for antisepsis, it's important to keep the chlorhexidine wet on the surface for at least thirty seconds. On the other hand, betadine disinfects as it dries, so for antisepsis you need to coat the surface and then wait for the betadine to dry before proceeding. The only time I've heard it's particularly important to allow chlorhexidine to dry completely is when doing neuraxial techniques due to concern for meningotoxicity.

 

[DM27]

From my understanding a large part of the drying time for stat cases is mostly attributed to the perceived increase fire risk when largely alcohol based preps are still wet if electrocautery is being used.

 

[deleted162650]

Yes, dry time is to prevent fire - has nothing to do with anti-microbial activity. Crash section gets betadine splash and slash at my shop. Interestingly enough, I can’t ever recall a crash section getting a wound infection.

 

[Psai]

Yes, dry time is to prevent fire - has nothing to do with anti-microbial activity. Crash section gets betadine splash and slash at my shop. Interestingly enough, I can’t ever recall a crash section getting a wound infection.

Probably because the surgery is fast and the patients are generally otherwise healthy

 

[anonperson]

Is it imperative to wait the 3 minutes to dry before proceeding?

What about in a Stat c section situation? Betadine?

If the CHG doesn't dry, there is a fire risk. Have a colleague who had this happen to.

Crash sections get betadine splash. I usually give them an additional dose of antibiotics post OP as well in this situation. No evidence but makes me sleep better at night.

 

[acidbase1]

Thanks boys!

 

[anbuitachi]

yea i mean how often does a healthy person get an infection due to skin cuts? you fall and blood up your knees, do you get an infection? i hope not.

 

[deleted162650]

yea i mean how often does a healthy person get an infection due to skin cuts? you fall and blood up your knees, do you get an infection? i hope not.

You’re right. Why the F’ have we been messing around with skin prep and periop ABX all these years

 

[Psai]

You’re right. Why the F’ have we been messing around with skin prep and periop ABX all these years

Gyn has literature saying that if they are just going into the peritoneal cavity without going into the uterus they don't need periop antibiotics. They still prep the skin but don't want to give ancef before sticking those laparoscopy ports in.

 

[DocVapor]

Gyn has literature saying that if they are just going into the peritoneal cavity without going into the uterus they don't need periop antibiotics. They still prep the skin but don't want to give ancef before sticking those laparoscopy ports in.

Our Gyns started this probably a year-ish ago. No problems so far.

 

[pgg]

betadine disinfects as it dries, so for antisepsis you need to coat the surface and then wait for the betadine to dry before proceeding.

Is that really true? I know it's what I've been told for 20+ years but ...

Iodine kills in a couple ways. It's in a hyperosmolar solution that sucks water out of cells and kills by dessication ("dries" out bacteria). Halogens also have some effects on DNA synthesis and direct oxidative effects. Iodine specifically enters cells and binds to proteins and nucleotides causing destruction and death. All of this takes time, which passes while we sit around waiting for it to dry.

But none of this relies on on the vehicle it arrives in being "not wet" ...

 

[deleted162650]

Gyn has literature saying that if they are just going into the peritoneal cavity without going into the uterus they don't need periop antibiotics. They still prep the skin but don't want to give ancef before sticking those laparoscopy ports in.

I’m aware of that and some of our GYNs do that too but it makes no sense to me. The point of Ancef is to kill skin flora, not uterine flora. Why do all other surgical specialties want Ancef (and have literature) showing it reduces infection??

 

[HomeSkool]

Is that really true? I know it's what I've been told for 20+ years but ...

Iodine kills in a couple ways. It's in a hyperosmolar solution that sucks water out of cells and kills by dessication ("dries" out bacteria). Halogens also have some effects on DNA synthesis and direct oxidative effects. Iodine specifically enters cells and binds to proteins and nucleotides causing destruction and death. All of this takes time, which passes while we sit around waiting for it to dry.

But none of this relies on on the vehicle it arrives in being "not wet" ...

Good point. Could be that we were all taught to let it dry simply as a way of making sure enough time elapsed for it to do its job.

 

[Psai]

I’m aware of that and some of our GYNs do that too but it makes no sense to me. The point of Ancef is to kill skin flora, not uterine flora. Why do all other surgical specialties want Ancef (and have literature) showing it reduces infection??

Agree and I've been skeptical but I haven't seen any surgical site infections with any of my patients yet.