Align-ju STUDENT
Table 3. Comparison of chlorhexidine and povidone-iodine.
Factor Chlorhexidine Povidone-iodine
Antimicrobial properties
Broad spectrum – effective against many bacteria, and virucidal, fungicidal and sporicidal
Residual effect Long Shorter
Broad spectrum – bactericidal, fungicidal and virucidal
Organic material |
Effective in the presence of organic material |
Efficacy impaired by the presence of |
|
|
organic material |
Irritation Irritant to mucous membranes and ototoxic Not irritant
When to use |
When preparing the skin for surgery |
When preparing mucous membranes, |
|
|
such as eyes, open wounds or inside ears |
There is no definitive scrub technique that is considered the most efficient. One technique that can be used is to make concentric circles, starting from the planned incision site for the surgery and moving the swab in a circle outwards until the edge of the clipped area is reached. Another technique is the back-and-forth method, where each swab is moved back and forth across the clipped area, again starting where the incision site will be and working outwards to the edge of the clipped area [ 3 ].
The patient should continue to be scrubbed until the contact time for the chlorhexidine has been reached and the skin is visibly clean [ 6 ]. Chlorhexidine requires a minimum contact time of 3 minutes, and a 3 – 5-minute scrub is recommended for good residual activity [ 3 ].
Preparing the theatre
At the start of every day, the theatre should be damp dusted with a suitable disinfectant to remove any dust particles that may have settled overnight and ensure it is an aseptic area. Next, any other equipment required for the surgery, including the anaesthetic machine, suction and electrocautery, should be checked and set up.
Patient positioning
For an ex-lap, the patient is required to be in dorsal recumbency. Positioning aids such as sandbags and limb ties are needed to keep the patient in this position( Figure 2).
Although chlorhexidine has good residual action, it will protect the patient only for the duration of the surgery. To give more extended protection against bacteria, a final skin preparation should be carried out once the patient is in the theatre.
ChloraPrep( BD) is a pre-made sterile skin preparation consisting of 2 % chlorhexidine gluconate in 70 % alcohol [ 3 ]. It is a broad-spectrum bactericidal and bacteriostatic product and also has action against some fungi. It provides post-surgery protection for up to 48 hours [ 7 ]. Once opened, the ChloraPrep should be used starting from the incision site and working outwards to the edge of the clipped area in the same way as when scrubbing with chlorhexidine.
If ChloraPrep or a similar product is unavailable, a second skin preparation using a 1:1 dilution of chlorhexidine and sterile water can be applied with sterile swabs before spraying the area with alcohol [ 3 ].
Role of the circulating nurse
The circulating nurse is the team member who is not scrubbed into surgery to assist the VS. They have many roles before, during and after the surgery.
Figure 2. Patient positioning for an exploratory laparotomy.
Volume 41( 5) • October 2026
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