Visibility of Tinted Chlorhexidine Gluconate Skin Preparation on Varied Skin Pigmentations

Abstract

Preoperative skin preparation with antimicrobial agents decreases the risk of surgical site infection, but concerns have been raised about the visibility of a common surgical preparatory agent (ChloraPrep; Becton, Dickinson & Co, Franklin Lakes, New Jersey), depending on skin pigmentation. Poor visibility may lead to failure to identify inadequately prepared skin, increasing the risk of surgical site infection. This study was conducted to determine whether different tints of ChloraPrep and different skin pigmentations affect the ability of orthopedic surgeons to identify the adequacy of skin preparation. The forearms of volunteers in 4 skin pigmentation categories (fair, medium-fair, medium-dark, and dark) were prepared with Hi-Lite Orange and Scrub Teal ChloraPrep, with 1 forearm prepared adequately and 1 prepared inadequately. Videos showing the forearms were obtained and compiled into a survey that was sent to orthopedic surgeons, who were asked to assess the adequacy of skin preparation. When the 4 pigmentation categories were aggregated, no difference was noted between Hi-Lite Orange and Scrub Teal tints in rates of correct identification of adequate skin preparation by respondents. When the preparation tint was not controlled for, respondents correctly identified the adequacy of skin preparation for fair and medium-fair pigmentations, but not for medium-dark and dark skin pigmentations. The Hi-Lite Orange tint was significantly easier to identify on fair and medium-fair skin pigmentations, and the Scrub Teal tint was easier to identify on medium-dark and dark skin pigmentations. To reduce the risk of surgical site infection, surgeons should use Hi-Lite Orange on patients whose skin is fair or medium-fair and Scrub Teal on patients whose skin is medium-dark or dark. [Orthopedics. 2017; 40(1):e44-e48.].

The Level of Surface Coverage of Surgical Site Disinfection Depends on the Visibility of the Antiseptic Agent—A Virtual Reality Randomized Controlled Trial

“…Pre-trial power analysis was performed using G*Power. A mean effect size according to McDaniel et al, an alpha-error of 5%, and a minimum power of 80% according to Cohen was assumed [ 8 , 9 ]. The result was a minimum sample of 128 participants, which was exceeded here with a sample of 141 participants [ 10 ].…”

“…Besides choosing the best agent for the most effective skin antisepsis, colored antiseptic solutions were introduced with the aim to visualize appropriate skin coverage by the skin disinfectant [ 8 ]. The effect of a colored skin preparation was studied with regard to the patients’ skin pigmentation [ 8 ].…”

“…Besides choosing the best agent for the most effective skin antisepsis, colored antiseptic solutions were introduced with the aim to visualize appropriate skin coverage by the skin disinfectant [ 8 ]. The effect of a colored skin preparation was studied with regard to the patients’ skin pigmentation [ 8 ]. McDaniel and co-authors showed videos of accurately and non-accurately prepared forearms to orthopedic surgeons that evaluated the adequacy of the skin preparation.…”

Guideline for preoperative patient skin antisepsis

“…A new recommendation was added that a tinted antiseptic that is most visible on the patient’s skin should be selected 1,6 . “There is no ‘one‐size‐fits‐all’ product that can be adequately seen on the wide range of skin tones across a patient population,” deKay noted.…”

Clinical Issues—June 2021

“…The AORN “Guideline for preoperative patient skin antisepsis” 1 recommends selecting a tinted antiseptic that is most visible on the individual patient’s skin. In a study to determine the adequacy of skin preparation coverage when using two tinted alcohol‐based chlorhexidine gluconate preparations on the forearms of individuals with four different skin pigmentations (ie, fair, medium‐fair, medium‐dark, dark), researchers found that orange tint was significantly easier to identify on fair and medium‐fair skin tones and teal tint was easier to identify on medium‐dark and dark skin tones 2 …”