Q: Local Cases

Is it acceptable to have patients that are having straight locals wear their street clothes into the OR? Also, some surgeons are requesting that the patients only have BP and pulse ox, not EKG monitoring. Is this acceptable?

A: Quick turnovers are always an issue, but unfortunately anyone entering the OR needs to be in proper OR attire, including the patient. The patient needs to be clean, in a clean patient gown (facility socks), head covering and clean linen.
Page 111 (I.d.) in the 2018 AORN Guidelines states: “That anyone entering the OR semi-restricted or restricted, including police officers, parents, biomedical engineers, should don either clean scrub attire, or a single use jumpsuit, even when entering for a brief period of time.”

A: If you do other cases in that OR that are at risk
for SSI then you cannot allow street clothes. We don’t do EKG monitoring on straight locals.

A: As for attire to be worn within the surgical suite, I agree that anyone entering the OR needs to be in proper OR attire. As for the question regarding the appropriateness of EKG monitoring, I would direct any nursing clinician to review Recommendation II, from AORN’s 2017 Guideline for Care of the Patient Receiving Local Anesthesia, page 620, regarding determining need for EKG monitoring.

Q: Skin Prep

Does anyone have any other alternatives to a skin prep solution or cleanser if 3.3% Choroxlenol (ScrubCare) by Care Fusion is not available? This product is no longer manufactured. If the patient is allergic to betadine, CHG and the cleanser is needed for a facial, perineal or vaginal area, what are your institutions using? Some suggestions were J&J baby shampoo, diluted hydrogen peroxide with a water rinse and bar soap. Many institutions no longer have bar soap.

A: Below is from an abstract for a study regarding use of baby shampoo as a vaginal prep solution. Bar soap should not be an option, as some contain Triclosan. “CONCLUSION: Baby shampoo should be studied as an alternative to povidone-iodine (PI) because it is a nonirritating, inexpensive mild detergent. This preliminary study suggests that baby shampoo is as effective as PI in preventing postoperative infection.”

A:  More studies should be conducted.

A:  Agreed. There are a few studies out there, and we do have baby shampoo on formulary, however, it is off-label use according to J&J.”