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13 Executive Briefing 3 EXECUTIVE BRIEFING works to reestablish the epithelial barrier and promote wound closure over days to weeks. 7 Many factors can lead to impaired healing of wounds, including bacterial colonization. 8 Q: What is the benefit of a skin antiseptic with a sterile solution? LP: Over the past 20 years, there have been published reports linking outbreaks of infection to over-the-counter (OTC) topical antiseptic agents. Topical antiseptics for preinjection or preoperative skin preparation that were contaminated with microorganisms and have led to product recalls 9 from both intrinsic and extrinsic sources. Contamination can be intrinsic when microorganisms are introduced into a product during the manufacturing process either from pharmaceutical water supplies or nonsterile manufacturing environments. Extrinsic contamination occurs when microorganisms are introduced in association with product use. For example, products can become contaminated when diluted with nonsterile water or transferred for storage into nonsterile containers. Sterile means the solution is free of microorganisms (any microscopic organism such as bacteria). Labeling stating a product is sterile means it was treated with a process during manufacturing to eliminate all potential microorganisms. 10 Though not currently required by the FDA, some manufacturers have taken this extra step to sterilize both the applicators and solution where there is less than one in a million chance that a viable microorganism can exist in the antiseptic.¹¹ Q: What are the benefits of dual formulation antiseptics versus single-agent preps? LP: Using a dual formation antiseptic provides two modes and mechanisms for killing microorganisms. Alcohol has a rapid-acting, broad-spectrum activity against gram-positive and gram-negative bacteria as well as most fungi and virus by denaturing cell proteins. The American College of Surgeons suggests an Alcohol-containing preparation should be used unless contraindication exists. 12 Dual formation antiseptics with alcohol have been proven to be more effective than single agent preps.¹³ Chlorhexidine has advantages though over iodophors as a skin antiseptic because it is persistent, effective in the presence of blood and organic matter, and shown to have less sensitivity by patients. 14 Antiseptics with chlorhexidine and alcohol have been recommended by the WHO. 15 Lastly, AORN recommends using alcohol with an iodophor or chlorhexidine based on the patient assessment and surgical anatomic site.¹ Q: What do you see as the biggest challenges to skin prep compliance? LP: There are multiple factors impacting the correct use of skin antiseptics. A 2016 research article published in International Surgery Journal showed 257 hospitals across the US only achieved adequate prep and dry time 25% of the time. Hospitals see some of this variability from using multiple step processes when applying different antiseptics for a procedure. 16 Variability can also include not having an evidence-based standardized process and selected skin prep throughout the facility. Lastly, continuous education for both the nursing staff and surgeons is critical to ensure competency and compliance. This content is sponsored by BD and contains the opinions of Lena Pearson. The opinions presented herein are for information purposes only and the decision of which antiseptic to use in a particular procedure should be made by the surgeon based on the individual facts and circumstances of the patient. Lena Pearson is an employee of BD. This Q&A, sponsored by BD, is intended to educate, and train customers regarding the approved use of BD products. As such, unapproved products or indications are not discussed herein. You may contact BD's Office of Medical Affairs at Medical.information@bd.com for any specific clinical questions you may have. References 1. AORN Guidelines for Perioperative Practice: Patient Skin Antisepsis 2. G. W. Denton, "Chlorhexidine," In: S. S. Block, Ed., Disinfection, Sterilization, and Preservation, 5th Edition. Lippincot Williams & Wilkins, Philadelphia, 2001, pp. 321-336. 3. Young JM, et al. Nat Clin Pract Gastroenterol Hepatol. 2009;6(2):82-91. 4. Govani SM, et al. Gastroenterol Hepatol. 2012;8(4):241-248. 5. FDA 12/20/2017 - Final Rule: Finalizes rulemaking for healthcare antiseptics 6. Beausoleil C, Comstock SL, Werner D, Li L, Eby JM, Zook EC. Antimicrobial persistence of two alcoholic preoperative skin preparation solutions. J Hosp Infect. 2022 Nov;129:8-16 7. desJardins-Park HE, Mascharak S, Chinta MS, Wan DC, Longaker MT. The Spectrum of Scarring in Craniofacial Wound Repair. Front Physiol. 2019 Mar 29; 10:322 8. Wallace HA, Basehore BM, Zito PM. Wound Healing Phases. In: StatPearls. Treasure Island (FL): StatPearls Publishing 9. Weber DJ, Rutala WA, Sickbert-Bennett EE. Outbreaks associated with contaminated antiseptics and disinfectants. Antimicrob Agents Chemother. 2007 Dec;51(12):4217-24. 10. FDA Drug Safety Communication 2013 Nov 13 11. Degala, et al. United States Patent 9,078,934. July 14, 2015 12. Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KM, Dellinger EP, Ko CY, Duane TM. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017 Jan;224(1):59-74. 13. Darouiche RO, Et al. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. N Engl J Med. 2010 Jan 7;362(1):18-26. 14. Mangram AJ, et al. Infect Control Hosp Epidemiol. 1999;20(4):247-278 15. Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization; 2018 16. El-Othmani MM, et al. Assessment of standardization in surgical site preparation: does a compliance culture exist? Int Surg J 2016; 3:1-10. BD, the BD Logo, ChloraPrep and the Sterile Solutions logo are trademarks of Becton, Dickinson and Company or its affiliates. © 2023 BD. All rights reserved. BD is one of the largest global medical technology companies in the world and is advancing the world of health™ by improving medical discovery, diagnostics and the delivery of care. The company supports the heroes on the frontlines of healthcare by developing innovative technology, services and solutions that help advance both clinical therapy for patients and clinical process for healthcare providers.