Assessment of standardization in surgical skin preparation: does a compliance-culture exist?

Abstract

Background: Proper and adequate surgical site preparation is a vital part of reducing postoperative morbidity, mortality, and overall health care costs. A major key to improve quality-of-care is the compliance with standardized procedures that reduce variations. Methods: We conducted a prospective, observational study in 257 hospitals across the US to assess standardization-rates of surgical-site skin-preparation. The adequacy of surgical skin-prepping duration and the drying-time as defined by the directions-for-use of each product were assessed. Results: Our results showed a 24.6% compliance rate with both application and dry times, while 38.8% of hospitals were noncompliant with either application-time or dry-time. The use of a single-step applicator, a central-to-peripheral application, chlorhexidine-alcohol, and performing a single prep were correlated with higher compliance rates. The use of a 2-step application, aqueous-chlorhexidine, iodine, iodine-alcohol, and performing two or more total preps all showed a higher correlation with overall non-compliance. The compliance with adequate prep-time or dry-time was significantly correlated with higher compliance with both variables. Conclusions: Among hospitals included in this study, the compliance rates with standardized recommendations were low and might be an indicator to drawbacks that extend beyond the act of skin preparation. The adequacy of skin preparation might be an indicator of the status of a compliance-culture and of the delivered–care quality.