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Preoperative Vaginal Preparations (PVP): Practice Implications Of Guidelines And Research Studies Review


Purposes: Surgical Site Infections (SSIs) create a gamut of implications to the health care facilities, providers, delivery models, and costs besides the impact that affects the patient and their significant others. The causes of SSIs are complex and multiple but the majority is known to arise from the surgical patientís own native bacteria. Preoperative vaginal preparation (PVP) is a preventive intervention to SSIs in surgeries involving the female reproductive system. Further scrutiny of guidelines, current practices and research studies is crucial in deducing implications to practices based on these evidences. The purposes of this literature review are 1) to examine current PVP guidelines set by: Association of Operating Room Nurses (AORN), Center for Diseases Control and Prevention (CDC), Joint Commission on Accreditation of Hospital Organizations (JCAHO), Food and Drug Administration (FDA), and Manufacturers; 2) to scrutinize research studies on PVP and synthesize the data; and 3) to draw practice implications from the review. Search Strategy: Electronic search was utilized to locate guidelines and research studies on PVP. Websites of organizations are the sources of the guidelines. MEDLINE search on PVP studies was used. References on the research studies were located as well to get pertinent literature. Results and Synthesis of Evidence: 1. Guidelines emphasized using approved antiseptics and in accordance to manufacturerís instructions. Manufacturer states 4% Chlorhexidine Gluconate (CHG) should not be used in the genitalia, 7.5% Povidone Iodine (PI) scrub is for external use only, 10% PI solution is indicated as a PVP agent by some manufacturers but others label it for external use only. 2. Manufacturer guidelines are not followed in practice settings as well as in research studies. That is, off label usage of agents as PVP is noted. However, the agents have potential to decrease infection morbidities but non usage of such does not differ significantly. Besides, the agents when used in PVP were also implicated for negative patient outcomes. Baby shampoo with normal saline is a potential PVP agent but this warrants further investigation. Practice Implications: 1.1) Usage of PVP agents should be based on AORN, CDC, JCAHO, FDA, manufacturerís guidelines and current evidence. 1.2) Decision in the off label usage of PVP agents requires multidisciplinary consideration and the affirmative decision to do so places the health care facility in assuming liability. 2.1) CHG and 10% PI solution have potential to decrease infection morbidities, however, the results do not differ significantly with non usage of PVP. 2.2) Patient characteristics, safety and clinical outcomes are of utmost consideration in the usage of PVP agents. 2.3) Further research on potential PVP agents should be done to establish wider product selection that results to positive patient outcomes. References: Please refer to poster Disclosure: There is non-FDA use of medical devices or pharmaceutical products included in this poster.

Primary Author:

Judith R. Garcia, MHSS MS BSN RN CNOR
Staff Nurse, Ohio State University and Medical Center

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