Skin Prep with ChloraPrep Simulation

• Click the ‘Sign In’ tab above to login with your UF credentials OR to create a free account.
• Read the "Simulation and Context" information below.
• Click the ‘Launch Content’ button below to open the simulation.
• Access the scenario instructions by clicking the arrow in the "Scenarios" section below.
• When you are finished with the course content, click the button to take the Post-Test.

The ChloraPrep applicator contains a combination of 2% chlorhexidine gluconate (CHG) and 70% isopropyl alcohol (IPA) and comes in multiple sizes (1, 1.5, 3, 10.5, 26 mL). It is intended to reduce microorganisms on the skin before invasive medical procedures like surgical incision and central venous catheter placement to help prevent surgical site infections. CHG has persistent activity; IPA rapid bacterial killing.

The right size of applicator needs to be selected for the given area to be disinfected. Too large an applicator may create runs of liquid that pool and create a fire hazard if cautery is used and the pools are not wiped dry and the alcohol vapors have not dissipated. Isopropyl alcohol from liquid ChloraPrep solution can evaporate and provide the fuel for the fire triangle: ignition, fuel, oxidizer. Liquid pools of ChloraPrep solution must be wiped dry. Too small an applicator will require more than one applicator for adequate coverage. The ChloraPrep simulation provides only the 26 mL applicator. You can use more than one applicator in the simulation after dragging the applicator into the garbage can to discard it.

In the Instructions for Use, the manufacturer of the ChloraPrep recommends a to-and-fro motion of the applicator, instead of the traditional outward concentric circular pattern that starts at the planned site of incision and spirals outward from the incision site. The traditional spiral creates coverage in only one direction over any particular small area of skin.  This can be observed in the simulation. Considering the magnified skin (i.e., at the microscopic level) as a stucco wall with peaks and valleys, coverage in only one direction will leave parts of the skin unexposed to the ChloraPrep solution and thus not disinfected, as you may have observed if you have painted a stucco wall.

The to-and-fro skin prep pattern will also help with any body hair that could shield underlying skin from the prep if it were only applied in one direction. Lastly, a to-and-fro prepping motion also acts as a gentle form of debridement of dead skin cells to allow prep to get underneath where they were.

Click the arrow to the left to expand the section below.

Steps: 

1.   Open the skin prep simulator. A 26 mL applicator appears.
2.   Click and drag the applicator to the dashed line representing the planned incision site.
   
3. Click and drag the applicator in the traditional circular scrubbing pattern, either clockwise or counterclockwise. Notice how the applicator is travelling in only one direction for any given section of skin relative to the incision site. For example, with a counterclockwise scrubbing pattern, the applicator is always travelling in the right to left direction.
   
4. When you have completed the scrubbing, click the Draping button. Define the sterile field by individually clicking and dragging on each of the four blue towels. When done, click the Review button.
5. After the scoring is completed, click on the Coverage in 1 Direction button. Observe the coverage in one direction as a percentage of the defined sterile field. Click on the Coverage in 2 Directions button and observe that the coverage percentage is lower in 2 directions compared to one direction. 

Scenario notes:

The traditional concentric circular scrubbing pattern provides unidirectional coverage (coverage in only one direction that leaves parts of the skin untreated) and is not the one indicated by the manufacturer of the ChloraPrep.

Scenario 2

Click the arrow to the left to expand the section below.

Steps:

1. Press the New Patient button to relaunch the skin prep simulator
2. Click and drag the applicator to the dashed line representing the planned incision site.
   
3. Click and drag the applicator in a to-and-fro scrubbing pattern.
   
4. When you have completed the scrubbing, drape the sterile field by clicking and dragging the four blue towels, one at a time.
5. When draping is completed, click Review and explore the available thumbnails when scoring is completed. Observe how the coverage as a percentage of the sterile field is larger in two directions than in one direction.

Scenario notes:
A to-and-fro scrubbing pattern provides coverage in at least 2 directions and is indicated when using the ChloraPrep applicator.