EP 639 Surgical Asepsis at University Hospitals of North Midlands (UHNM)

Background

Effective preoperative skin antisepsis is a fundamental component of surgical site infection (SSI) prevention. NICE guideline NG125 (2019) stipulates alcohol-based chlorhexidine as first-line skin preparation unless contraindicated for example where mucous membranes are involved. Anecdotal evidence at University Hospitals of North Midlands (UHNM) suggested that current practice was not consistently aligned with national guidance.

Aim

To audit the choice of skin preparation practices in surgery at UHNM, assess compliance with NICE NG125 guidelines, and determine whether educational interventions could improve adherence.

Methods

An initial two-week observational audit reviewed 80 general surgical procedures. Data on antiseptic agent choice were collected through direct observation in theatre. Findings were shared with the surgical and theatre teams, followed by targeted educational feedback. A first re-audit cycle assessed early impact. Subsequently, guideline posters summarising NICE NG125 recommendations were displayed throughout operating theatres. A second re-audit cycle was then completed.

Results

Initially 70% of cases used iodine (Betadine) and 30% used aqueous chlorhexidine.

Following educational intervention, the first re-audit demonstrated increased use of alcohol-based chlorhexidine, with 50% of cases using ChloroPrep and 50% using betadine.

After the introduction of guideline posters, the second re-audit showed 100% compliance with NICE NG125 guidelines, with all cases using appropriate first-line skin antisepsis.

Conclusion

The audit identified a clear deviation from national standards in preoperative skin antisepsis. Simple educational interventions resulted in improved compliance. Ongoing education and re-audit are recommended to maintain best practice.