Preoperative Skin Preparation Protocol
Use chlorhexidine-alcohol solution (2% chlorhexidine gluconate in 70% isopropyl alcohol) for preoperative skin antisepsis in all surgical patients unless contraindicated by allergy or anatomical site. 1, 2
Allergy Screening Protocol
Before any skin preparation, screen for contraindications during the pre-operative assessment phase:
- Ask specifically about latex allergy by inquiring whether contact with balloons, condoms, or latex gloves provokes itching, rash, or angioedema 3, 4
- Document chlorhexidine allergy history in case notes and on the patient's wrist bracelet 3, 4
- Identify high-risk latex allergy patients: healthcare workers, children with spina bifida or multiple prior surgeries, patients with severe hand dermatitis, those with fruit allergies (banana, chestnut, avocado), and atopic individuals 3
- For positive or equivocal allergy history, refer for latex-specific IgE testing or skin prick testing before elective surgery; proceed only in emergencies 3, 4
Standard Skin Antisepsis Protocol
For patients without contraindications:
- Apply 2% chlorhexidine gluconate in 70% alcohol liberally to the surgical site 1, 2, 5
- Scrub vigorously for at least 2 minutes using a circular motion starting from the incision site and moving outward 6, 5
- Allow to dry completely with a sterile towel 5
- Repeat the application for an additional 2 minutes and dry again with a sterile towel 5
- Ensure complete drying before proceeding to achieve full bacteriostatic effect 6
Alternative Antiseptic for Contraindications
When chlorhexidine-alcohol is contraindicated, use povidone-iodine for:
- Procedures involving ear, eye, mouth, mucous membranes, or neural tissue 7
- Infants under 2 months of age (chlorhexidine may cause irritation or chemical burns) 5
- Patients with documented alcohol or chlorhexidine allergy 1, 5
- Head or face preoperative preparation 5
Latex Allergy Precautions
If latex allergy is confirmed:
- Schedule patient first on the operating list and prepare the theatre the night before to minimize airborne latex particles 3
- Place "Latex allergy" notices on anaesthetic room and operating theatre doors 3
- Use only synthetic gloves for all equipment preparation, anaesthesia, surgery, and postoperative care 3
- Remove non-essential equipment from the patient vicinity 3
- Ensure resuscitation boxes contain only latex-free materials 3
Critical Safety Warnings
Do not use chlorhexidine:
- In contact with meninges, middle ear through perforated eardrums, or genital areas 5
- In the eye (may cause permanent injury) or ear canal (may cause deafness) 5
- On wounds involving more than superficial skin layers for routine treatment 5
If chlorhexidine contacts eyes, ears, or mouth, rinse immediately and thoroughly with water 5
Common Pitfalls to Avoid
- Insufficient drying time before incision reduces antiseptic efficacy 6
- Inadequate contact time (less than 2 minutes per application) fails to achieve full bacteriostatic effect 6, 5
- Contamination of sterile equipment with antiseptic solutions during application 6
- Proceeding with elective surgery when allergy history is incomplete or suggests previous perioperative reaction 4
- Using latex gloves in patients with documented latex sensitivity, even for "brief" contact 3