Kill.Keep killing.

Clinical studies* have proven the efficacy and persistence of Hibiclens,demonstrating how it goes to workon germs and provides a cumulativeeffect that continues to kill germslong after your shift is over.The most recent study observed agarplates that were inoculated with staphaureus. Hands were washed withHibiclens, and then pressed onto the inoculated plates – palms down.The plates were then incubated and a whitish film of staph aureus grew inareas not affected by Hibiclens.

For persistent antiseptic activity, you’re in the clear with Hibiclens.®

From the makers of Hibiclens® and Biogel®. www.regentmedical.com.Regent, Biogel, Hibiclens, Regent logo, Biogel logo, and Hibiclens logo,are trade marks of Regent Medical, Ltd. Distributed by Regent Medical,Americas, LLC, Norcross, GA 30092. ©2005 Regent Medical, Ltd. All rights reserved.

*Test on file.**The darker color in the hand print shows the cumulative effect

of Hibiclens on staph aureus, the fifth day of use, 6 hours afterthe final daily handwash.The persistence of Hibiclens provides extra protection.Recommended antiseptic procedures of your institution shouldbe followed when using Hibiclens.

Hibiclens, armed with its 4% Hibitane (CHG)formulation immediately killed germs and displayed a cumulative effectthat didn’t know when to quit.In fact, this demonstrationshowed the antiseptic stillkilling on the fifth day of useand 6 hours after the final daily handwash.**

Immediately kill and keep killing germs withHibiclens. For more information, call 1-800-843-8497.

Circle 39 on Reader Service Card

Before surgeryYou can prep,

or you can ChloraPrep®

chlorhexidine gluconate 2% w/v & isopropyl alcohol 70% v/v

Medi-Flex, Inc. • 800-523-0502 • www.chloraprep.com©2005 Medi-Flex, Inc. ADV-103 1/05

ChloraPrep® is an FDA approved preoperative skin preparation,proven to be fast-acting, broad-spectrum, and persistent.

Circle 108 on Reader Service Card

Magazine r

OutpatientSurgery

www outpatientsurgery.net

One-Stop Guide toSurgical Skin PrepsA 16-page pullout designed to make the task of evaluating skin preps quick and convenient for you.BETADINE® 5% Ster ile

Ophthalmic Prep Solution(povidone-iodine ophthalmic solution) (0.05% avail able iodine)

� Only Povidone-Iodine Product Indicated for Use on the Eye� Dual Use: Corneal Irrigation and Periocular Antiseptic� Correct Isotonic Balance � Non-irritating � Sterile

BETA

DIN

E® Eye P

rep Why Risk Im prop er ly

Mixed So lu tions?

Availablein

Alcon Laboratories, Inc. 6201 South Freeway Fort Worth, TX 761341-800-TO-ALCON (1-800-862-5266) Outside US: Contact Your Local Alcon Representative

©2003 Alcon, Inc. DIS109 Printed in USACircle 55 on Reader Service Card

One-Stop Guide toSurgical Skin Preps

ANSWERS TO ALL YOUR QUESTIONS

• HOW QUICKLY DOES THE PREP START WORKING?

• DO YOU NEED SPECIAL REMOVAL SOLUTIONS?

• HOW LONG SHOULD EACH PREP TAKE?

• DO BLOOD, SALINE OR ALCOHOL CHALLENGES

Magazine r

OutpatientSurgery

www outpatientsurgery.net

WEAKEN OR INACTIVATE IT?

EFFICACYEFFICIENCY COMPATIBILITY PRODUCT INFORMATION

In Vitro Testing** In Vivo Testing**

Product Manufacturer Uses

FDA

Category*

Kill Rate

(%)

Time to

Achieve Kill

Rate (min)

Meet FDA log

Reduction

Standards? Persistence

Inactivated or

Weakened by any

Known Substances?

Water

Soluble? # Application Steps

Required

Application/

Contact Time

Required Drying

Time On Skin

Compatible

with all

Gloves?

Irritating to

Mucous

Membranes/Eyes?

Active

Ingredient(s) Stain?

Available

Applicators Sizes Flammable? Removal Procedure

Primary Benefits

(manufacturer’s claims) Other Considerations

DuraPrepSurgicalSolution

3Mwww.3M.com

Patient pre-op skin prep. Not for use near eyes, in ears

or on mucous membranes.

I^ 99.999 1 minute (earliest time

tested)

Yes Kills bacteria con-tacting the film forup to 12 hours aftera blood and saline

challenge

None No One-step paint Begins killingbacteria on

contact

2 to 3 minutes Yes Yes/Moderate eyeirritant

Isopropyl alcohol74%/iodophor (avail-

able iodine 0.7%)

Yes but removable frommost materials

Self-contained,unit-dose applicator

6mL, 26mL Yes while wet.Not

flammablewhen dry.

Intended to be left onskin. Can be removed

with 3M RemoverLotion or alcohol-saturated gauze.

Dries to a polymer film that enhancesdrape adhesion, optimizes the persistent

effects of iodine, and resists wash-off.

Soap can interfere with adherence; skin must be clean,

dry and residue-free before application. Keep fingers/toesseparated until dry to prevent

skin-to-skin adherence.

Betadine 5%OphthalmicSterile PrepSolution

Alcon Laboratories Periocular prepping and ocular irrigation

NDA Not Available Not Available Yes (periocular skin

testing)

Not Available Not Available Yes For lashes and lid margins: Apply twice. For lids, brows and

cheeks: Apply 4 times.For ocular surfaces:

Irrigate once.

Ocular surfaces:2 minutes

Not Applicable Yes No Povidone iodine 5%(0.5% available iodine)

Yes No(bottles)

30mL No Flush from ocular sur-faces after 2 minutes

No premixing required.

PovidoneIodine Prepand ScrubSolutions

Aplicare, Inc.www.aplicare.com

Patient pre-op skin prep I Average log reduction >7.0

3 minutes Yes^^ Not Measured None known whenused at full strength

on intact skin

Yes Traditional two-stepscrub and paint

operation

Scrub for 5 minutes, blotwith steriletowel, apply

paint, allow todry

Dependent onmany factors

(ambient tempera-ture, humidity,patient’s skin,

surgical site, forexample)

No known reaction with

gloves

No/No Scrub solution 7.5%povidone-iodine(0.75% available

iodine); prep (paint)solution 10% povi-done-iodine (1%available iodine)

Will not stainnatural fabrics

or skin

Bottles, pumpspray bottles,

saturatedsponges

2-, 4-, 8-, 16-,32- and 128-ozbottles, 2-oz

sprayer, wingsponges, stick

sponges

No Use soap and water toremove from skin and

natural fabrics

Fast acting, broad spectrum, cost effective, non-flammable and non-

irritating. Saturated stick and wingsponges offer sterile liquid and sterile

applicator. Pump spray offers touchless,uniform application of paint.

Scrub CarebrandPrevail-Fx

Cardinal Healthwww.cardinal.com/scrubcare

Patient pre-op skin prep I 99.9999 15 seconds Yes Low bacterialcounts through 96

hours (3.3 logreduction at 96

hours)

Inactivated by solution containing

greater than 25%whole blood

Fluid resistant One step 30 seconds 2 to 3 minutes Yes Yes, due to alcohol Isopropyl alcohol72.5%/povidone iodine8.3% (0.83% available

iodine)

Yes. Removablewith sodiumthiosulfate solutions.

One-step, self-containedapplicator

10mL, 40mL Yes while wet.Not

flammablewhen dry.

High-pH soap andwater or rubbing

alcohol

Offers high log reductions. Maintains persistence through 96 hours post-

application. Large amount of solution inone applicator. No special remover lotion

or sharps disposal required (no glass ampoule).

Scrub Carebrand PVP-ISolutions

Cardinal Healthwww.cardinal.com/scrubcare

Patient pre-op skin prep.(Tested safe for mucous

membrane and eye preps.)

I 99.9609 3 minutes Yes Low bacterialcounts through

24 hours

Inactivated by solution containing

greater than 25%whole blood

Yes Traditional two-stepscrub and paint

operation

5 minutes toprep

Blot dry Yes No Povidone iodine 7.5%scrub solution (0.75%available iodine) and

10% paint solution (1%available iodine)

Yes. Removablewith sodiumthiosulfate solutions.

Standard prepkits,

impregnatedfoil pouches, bulk bottles

2-oz to 1-galsizes, 4-oz gel,also availablein prep trays

No Water High efficacy with traditional methods ofprep. No limitations on areas of use. Wide

variety of prep trays obviate need for expensive customization.

Scrub CarebrandExidine

Cardinal Healthwww.cardinal.com/scrubcare

Patient pre-op skin prep.Not for use near eyes, in ears

or on mucous membranes.

NDA Not Available Not Available Yes Goodpersistence

None Yes Two coats required 4 minutes total(2-minute scrub,

blot, 2-minutescrub, blot)

Blot dry Yes Yes Chlorhexidine gluconate 2% & 4%

Will stain brownif launderedwith bleach-containingdetergents

Standard prepkits or bulk

bottles

4-oz to 1-galsizes in bulk;also in prep

trays

No Water For patients with iodine sensitivity.

Techni-CareSurgicalScrub, Pre-and Post-OpSolution

Care-Tech Laboratories, Inc.www.caretechlabs.com

Patient pre-op skin prep.Safe for mucous

membranes.

I/III† 99.99 30 seconds Yes†† >6 hours None Yes One step 2-minute exposure time

Not necessary Yes No/Mild eye irritant Chloroxylenol 3.0%(PCMX)/

cocamidopropyl PG-dimonium chloride

phosphate 3.0%

4-ounce sizeavailable withfood-grade dye

for surgeonswho prefer skin

stain

No(bottles and

pumps)

4-oz to 1-galsizes; 12-mL

unidose;scrub/prep

brushes

No Intended to remain on skin

Transdermal penetration. Non-toxic byoral ingestion. Can be used in a bottle

warmer. Contains no alcohol. Contains emollients/skin conditioners.

Low allergic reaction ratio.

Can be used for incision/sitemaintenance and wound care.

O N E - S T O P G U I D E T O S U R G I C A L S K I N P R E P S

OutpatientSurgery

*Prep product categories: Category I: Generally recognized as safe and effective, not misbranded; Category II: Not generally recognized as safe and effective or misbranded; Category III: Available data insufficient to classify as safe and effective, further testing required. NDA: New Drug Application.**Per FDA’s proposed standards in the Tentative Final Monograph: “Kill rate” is the % of a standardized collection of common pathogens and their clinical isolates killed after prep application. The “log reduction standards” measure how well the prep reduces the microbial load on the skin. FDA suggests reductions of up to 2 log10/cm2 on dry skin sites (abdomen) and up to 3 log10/cm2 on moist sites (inguinal area) within 10 minutes of prep application. According to the FDA proposal, a product is “persistent” when microbial skin counts stay below baseline for 6 hours post-prep.^FDA lists this isopropyl alcohol concentration as category I. Iodophor is not listed but many iodine-containing ingredients are; the company says iodophor is an iodine that is buffered to reduce skin irritation. The TFM does not categorize the combination formula. ^^Scrub and prep tested separately. Each product meets the proposed standards, according to the manufacturer.†Chloroxylenol 3.0% is categorized by FDA as “I” for safety and “III” for effectiveness in the 1994 TFM. The firm notes that the ingredient was “monographed” by FDA prior to 1987 and has a long history of international use. Cocamidopropyl PG-dimonium chloride phosphate 3.0% has not been categorized, nor has the combination formula. ††Care-Tech’s in-vivo test results are expressed as “99.8% reduction for 24 hours on occluded sites,” which the company says exceeds the FDA TFM log-reduction standards.

Cardinal Health prep products offer superior efficacy and convenience

Scrub Care® Prep Trays

• Scrub Care® PVP-I solutions are broad spectrum, fast acting

and long lasting

• Proven safe, effective and nonirritating

• Variety of sizes and application methods allows for a customized

prep for many types of procedures

Prevail-Fx® One-Step Prep Solution

• 99.999% bacterial kill in 15 seconds

• 30-second, one-step application reduces valuable prep time

• Tested against 25 ATCC microorganisms and clinical isolates

• Two sizes available, 40mL and 10mL, for a variety of procedural needs

Scrub Care® Prep Trays and Prevail-Fx® One-Step Patient Prep

Cardinal HealthPrep Products 1500 Waukegan RoadMcGaw Park, IL 60085

www.cardinal.com/scrubcare

© Copyright 2005. Cardinal Health, Inc. or one of its subsidiaries.All rights reserved. (MC2329)

How much do you know about your prep?

For more information on the entire

line of Scrub Care® prep products,

including efficacy and safety data,

please visit our web site at

www.cardinal.com/scrubcare.

To place an order, call your Cardinal Health

sales representative or customer service

at 1.800.964.5227.

Betadine® Brand Microbicides promptly killmost gram-positive and gram-negativebacteria, as well as most viruses,fungi/yeasts, mycobacteria and protozoa –which makes them ideal for hand hygieneprior to patient care, surgical handscrubbing, and for topical degerming ofpatients’ skin prior to surgery and othermedical procedures.

“…antimicrobials increase thelikelihood of killing potentiallypathogenic bacteria.”*

*APIC Guidelines forHandwashing and HandAntisepsis in Health CareSettings. Am J Infect Control.1995;23:251-269.

“...handwashing can result inreductions inpatient morbidityand mortality from nosocomialinfection.”*

CL

EAN HANDS

SAVE LIVES

®

Insist on

BETADINE®

Microbicides

© 2005, Purdue Frederick, Stamford, CT 06901-3431 C7027-AD 1/05

Circle 58 on Reader Service Card Circle 4 on Reader Service Card Circle 74 on Reader Service Card

3M Infection Prevention Solutions.A Vital Step in Infection Prevention.

3M™ Avagard™ (Chlorhexidine Gluconate 1% Solution and Ethyl Alcohol 61% w/w) Surgical and Healthcare PersonnelHand Antiseptic with Moisturizers combines proven ingredients for effective, persistent antimicrobial activity with a uniqueemollient base clinically proven to reduce dryness and skin breakdown. It’s the only waterless, brushless hand antisepticthat is FDA-approved.* For more information call the 3M Health Care Customer Helpline at 800-228-3957.

*Unlike products rated FDA-compliant, Avagard surgical hand antiseptic has undergone FDA review andapproval (NDA-21074 June 7, 2001). So you have the confidence of knowing that all studies, testing andclinical research have been scrutinized, along with product claims and application instructions.

3M Technology delivers immediate,persistent antimicrobial activitywithout water or scrubbing.

Six Hour Persistence.Ninety Seconds to Apply.

© 3M 2004. All Rights Reserved. TM-0310

Circle 29 on Reader Service Card

EFFICACYEFFICIENCY COMPATIBILITY PRODUCT INFORMATION

In Vitro Testing** In Vivo Testing**

Product Manufacturer Uses

FDA

Category*

Kill Rate

(%)

Time to

Achieve Kill

Rate (min)

Meet FDA log

Reduction

Standards? Persistence

Inactivated or

Weakened by any

Known Substances?

Water

Soluble? # Application Steps

Required

Application/

Contact Time

Required Drying

Time On Skin

Compatible

with all

Gloves?

Irritating to

Mucous

Membranes/ Eyes?

Active

Ingredient(s) Stain?

Available

Applicators Sizes Flammable? Removal Procedure

Primary Benefits

(manufacturer’s claims) Other Considerations

Actiprep Healthpointwww.healthpoint.com

Patient pre-op skin prep. Not for use near eyes, in ears

or on mucous membranes.

I >99.9 15 seconds Yes 2 log reductionsmaintained at

24 hours

None Yes One step Begins killingbacteria on

contact

<2 minutes Yes Yes Alcohol 73% Yes. Basic soapremoves the

stain.

No(bulk solution)

2- and 16-ozbottles

Yes, while wet Soap and water CHG- and iodine-free. Exceeds FDArequirements when used alone. Whenused as a ‘prep system’ that includes a

pre-op shower with Triseptin body wash,prep site maintains significant microbial

reductions 48 hrs post-op. Alcohol-based, fast acting.

Contains a film former to aiddrape adherence.

ChloraPrep Medi-Flexwww.medi-flex.com

Patient pre-op skin prep. Not for use near eyes, in ears

or on mucous membranes.

NDA 99.99 15 seconds Yes At least 48 hours Some lotions containing lecithin

Yes One step 30 seconds (drysites), 2 minutes

(wet sites)

Dry sites: 30 seconds. Wet sites: 1 minute.

Yes Yes Chlorhexidine gluconate 2%/

isopropyl alcohol 70%

No Unit doseapplicators

3.0- and 10.5-mL dosed

applicators;0.67 mL SEPP

& 1.5mLFrepp

applicatorsfor small sites

Yes, while wet Intended to be left on skin

Fast acting, broad spectrum, persistent. Chlorhexidine 2% is preferred for preventing catheter-related

bloodstream infections (CDCGuidelines Category IA).

Povidone-Iodine PrepSolutions

Medlinewww.medline.com

Patient pre-op skin prep. Not for use near eyes, in ears

or on mucous membranes.

I >99.9 Within 60 seconds

Not Available Not Available(Some persistencedue to film-forming

capability)

High concentrationsof organics and

non-organic ions(chlorine and other

halogens, for example)

Yes One step (optional pre-cleansing)

3 to 5 minutes,until dry

Generally 2 to 5minutes

Yes Yes Povidone iodine 10%(1% available iodine)

Yes but can beremoved

Saturatedrayon preppad, rayonswabstick,

polyurethanesponge stick,polyurethanewing sponge

4-oz, 8-oz,pint, quart,

gallon bottles

No 70% isopropyl alcohol- or

1% sodium thiosulfate-impregnated gauze or

cloth

Broad spectrum. Effective against gram(+) and gram (-) bacteria, yeasts and

molds. Virucidal.

BetadineSolution

Purdue Products L.P.www.purduepharma.com

Patient pre-op skin prep. I 100 3 minutes (89% at 15 seconds)

Yes 6 to 8 hours Blood, pus, proteins Yes Traditional two-stepscrub and paint

operation

At least 2 minutes

None. Air dry ifdesired.

Not Available No/5% PVP-Isolution can be used

in the eye

Povidone-iodine 10%(1% available iodine)

Yes No 1/2-, 4-, 8-, 16-, 32-oz;1 gallon

No Wash off with water orwipe with alcohol pad

Proven effective. Reduces bacteria thatcan potentially cause skin

and wound infection.

Avoid pooling beneath thepatient. Prolonged exposure may

cause skin irritation.

Hibiclens Regent Medicalwww.us.regentweb.net

Patient pre-op skin prep.Not for use near eyes, in ears

or on mucous membranes.

NDA For S. epidermidis:99.375% at 20 sec.

99.96% at 1 minute^

See prior column

Yes At least 6 hours Anionic compounds Yes Two steps(repeat

application required)

2 minutes perapplication

None. Dry withsterile towel.

Yes Yes Chlorhexidine gluconate (CHG) 4%

Will stain brownif laundered

with bleach-con-taining deter-

gents

No 4-, 8-, 16-, 32-oz;

1 gallon

No None necessary Broad spectrum, persistent microbial kill.A “gold standard” of antiseptics.

Triadineand TriadPlus PVP-I10% PrepSolutions

Triad Disposableswww.triad-group.net

Patient pre-op skin prep. Safe for wounds and mucous membranes.

I Most organismskilled within

2 minutes

2 minutes Yes Some persistence(<1 day)

Reducing agentssuch as sodium thiosulfate; also

weakened by bloodand organic matter

Yes Three steps: After cleaning skin,

apply prep, repeat twice

1 to 5 minutes Complete dryingnot required

Yes No/No Povidone-iodine 10%(1% available iodine)

Does not stainskin (washes off

with water).May stain someclothes. Lemonjuice followedby immediatewashing may

remove persist-ent stains.

Pre-saturatedswabsticks,

sponge sticks,prep pads

2-, 4-, 8-, 16-,32-oz;

1 gallon

No Sterile gauze/sterile water

Flip-top bottles have easy-open wing-tabsafety seal. Triad Plus solutions/gels are

designed for procedural kit and tray manufacturers. Bottles can withstand

deep vacuum EtO cycles without leaking.

O N E - S T O P G U I D E T O S U R G I C A L S K I N P R E P S

OutpatientSurgery

*Prep product categories: Category I: Generally recognized as safe and effective, not misbranded; Category II: Not generally recognized as safe and effective or misbranded; Category III: Available data insufficient to classify as safe and effective, further testing required. NDA: New Drug Application.**Per FDA’s proposed standards in the Tentative Final Monograph: “Kill rate” is the % of a standardized collection of common pathogens and their clinical isolates killed after prep application. The “log reduction standards” measure how well the prep reduces the microbial load on the skin. FDA suggests reductions of up to 2 log10/cm2 on dry skin sites (abdomen) and up to 3 log10/cm2 on moist sites (inguinal area) within 10 minutes of prep application. According to the FDA proposal, a product is “persistent” when microbial skin counts stay below baseline for 6 hours post-prep.^Tested on a weaker (0.05%) CHG formulation than that in the prep product (4%).