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BD ChloraPrep™

Leading the way in effective pre-op skin prep

Overview
Applicators
The Formulation
FAQs
In-service resources

BD ChloraPrep™ patient preoperative skin preparation is a rapid-acting, persistent and broad spectrum antiseptic for a wide range of procedures.

The BD ChloraPrep™ formulation is the only antiseptic formulation whose persistent anti-microbial power has been confirmed in study after clinical study.

In fact, with more than 50 studies confirming why it belongs in every OR, BD ChloraPrep™ has been studied more than any other skin antiseptic brand.

Partnering with University Health, Georgia, we implemented BD ChloraPrep™ solutions to standardize processes and reduce variability to enhance outcomes, patient safety and surgical success. This video will show you how.

BD ChloraPrep™ patient preoperative skin preparation products

Skin prep you can trust.

The only 2% CHG / 70% IPA solution with > 50 clinical studies supporting its efficacy and safety; setting the standard of care in infection prevention for over 18 years.

Leading the way in effective pre-op skin prep and setting the standard of care in surgical infection prevention

ChloraPrep™ is the first antiseptic with a 2% chlorhexidine gluconate (CHG) / 70% isopropyl alcohol (IPA) formulation and provides distinct advantages over other products in how to prepare for surgery.

Below you can see the various traits of common antimicrobial agents used today.

Comparison of antimicrobial agents

Active agents	Traditional iodophors	Alcohol	Chlorhexidine*
Broad spectrum	X	X	X
Rapid bactericidal activity		X
Residual activity			X
Activity in blood/organic matter			X
Non/Minimal absorption			X

The BD ChloraPrep™ formulation uses a combination of chlorhexidine and isopropyl alcohol to provide both rapid killing of bacteria and persistent antimicrobial activity.

IPA rapidly kills microorganisms by denaturing cell proteins, while CHG maintains persistent antimicrobial activity by disrupting the cell membrane and precipitating cell contents. Additionally, CHG is able to bind to the skin and retain antimicrobial activity in the presence of blood and other organic material.

The unique dual formulation offered by BD ChloraPrep™ skin preparation has been shown to outperform iodine-based products. ^1,2,3

BD ChloraPrep™ is the only formulation whose persistent antimicrobial power was confirmed in study after clinical study. With a well-documented history in clinical practice, BD ChloraPrep™ skin preparation appears in Level I evidence based studies. In fact, the unique N% CHG and 70% IPA BD ChloraPrep™ formulation appears in more than 50 peer-reviewed publications.

“… because the efficacy of any formulation is significantly affected by the excipients present, trials demonstrating activity of one formulation can not be used as evidence for the efficacy of another.”

-Graham W. Denton

Denton G., Chlorhexdine. In: Block S, ed. Disinfection, Sterilisation and Preservation. 5th ed. Lippincott Williams and Wilkins. 2001

BD ChloraPrep™ meets third party evidence-based standards for preoperative skin antisepsis according to leading healthcare organizations. _^4,5,6

Comparison of antimicrobial agents

Active agents	Traditional iodophors	Alcohol
2016	World Health Organization (WHO)⁴	The panel recommends alcohol-based antiseptic solutions based on CHG for surgical skin site preparation.
2016	American College of Surgeons and Surgical Infection Society ⁵	Alcohol-containing preoperative skin preparatory agents should be used unless contraindication exists.
2017	Centers for Disease Control and Prevention(CDC)⁶	Perform intraoperative skin preparation withan alcohol-based antiseptic agent unless contraindicated.

* BD ChloraPrep™ patient preoperative skin preparation active agent

BD ChloraPrep™ is a rapid-acting and persistent preoperative skin preparation. Its proven formulation is available in six unique applicators designed for the right amount of solution for the right procedural area.

Advantages of BD ChloraPrep™ preoperative skin preparation include its broad spectrum, rapid-acting and persistent antimicrobial activity (at least 7 days¹), and effectiveness in the presence of blood and organic matter. These advantages are a result of the unique 2% CHG/70% IPA formulation of BD ChloraPrep™ preoperative skin preparation. Chlorhexidine gluconate, a cationic bisbiguanide, works by destroying the bacterial cell membrane and precipitating cell contents. Alcohol denatures cell proteins. As a result, BD ChloraPrep™ preoperative skin preparation provides better broad spectrum, immediate, cumulative and residual antibacterial activity compared to traditional iodophors. ² ³

Yes. After submitting a new drug application (NDA) to the Food and Drug Administration (FDA), BD ChloraPrep™ preoperative skin preparation received FDA approval in 2000.

When seeking Food and Drug Administration (FDA) approval for an over-the-counter antiseptic, all manufacturers of chlorhexidine-based solutions are required to submit a new drug application (NDA). The review of a NDA by the FDA includes evaluation of clinical, manufacturing and labeling information to assure the product is safe and effective.

Alcohol and iodophors were identified by the FDA as "generally recognized as safe and effective" (GRASE) and are included in the tentative final monograph from the FDA. As a result, manufacturers of alcohol, iodophors and iodine-based solutions can market products without submitting efficacy and safety data and product labeling to the FDA for review prior to marketing and selling their products.

Prepping time varies by the location and size of the prep site and applicator used.

Pinch

• Hold the applicator with the sponge down.

• Pinch the lever only once to activate the ampules and release the antiseptic.

Apply

• Wet the sponge by pressing and releasing the sponge against the treatment/

incision area until liquid is visible on the skin.

• Completely wet the treatment area with antiseptic.

Dry surgical sites (e.g., abdomen or arm)

– Use gentle, repeated back-and-forth strokes for 30 seconds.

Moist surgical sites (e.g., inguinal fold)

– Use gentle, repeated back-and-forth strokes for 2 minutes.

• Do not allow the solution to pool; tuck prep towels to absorb solution, and then remove.

Dry

• For safety and efficacy, allow the solution to completely dry. Follow labeled instructions per applicator package.

Prepping time varies by the location and size of the prep site and applicator. Prepping with BD ChloraPrep™ preoperative skin preparation is a procedure that, compared to the "scrub and paint technique," greatly reduces the amount of time required for patient preoperative skin preparation.

BD ChloraPrep™ preoperative skin preparation is for external use only.

Use with care in premature infants or infants under 2 months of age. These products may cause irritation or chemical burns.

BD ChloraPrep™ should not be used:

On patients with known allergies to chlorhexidine gluconate or isopropyl alcohol
For lumbar puncture or in contact with the meninges
On open skin wounds or as a general skin cleanser
In or around eyes, ears, and mouth. It may cause serious or permanent injury if it is permitted to enter and remain.
For lumbar puncture or in contact with the meninges
On open skin wounds or as a general skin cleanser
In or around eyes, ears, and mouth. It may cause serious or permanent injury if it is permitted to enter and remain.

Additional labeled warnings of BD ChloraPrep™ preoperative skin preparation include:

Solution contains alcohol and gives off flammable vapors—allow it to dry for three minutes on hairless skin.
Do not drape or use an ignition source (e.g., cautery, laser) until the solution is completely dry (allow it to dry for a minimum of three minutes on hairless skin; up to one hour in hair).
Avoid getting solution into hairy areas, as wet hair is flammable. Hair may take up to one hour to dry. Reduced dry time for smaller applicators.
Do not allow the solution to pool.
Remove any soaked materials, drapes and gowns before using ignition sources.
Whenever prepping the neck area, place towels under each side to absorb excess solution and then remove.

Use with care in premature infants or infants under 2 months of age. These products may cause irritation or chemical burns.

Each BD ChloraPrep™ applicator is appropriate for a variety of procedures, depending on the size of the area that needs to be prepped.

26 mL BD ChloraPrep™ applicator (~13.2 in x ~13.2 in)

10.5 mL BD ChloraPrep™ applicator (~8.4 in x ~8.4 in)

3 mL BD ChloraPrep™ applicator (~4 in x ~5 in)

1 mL and FREPP™ 1.5 mL BD ChloraPrep™ applicators and ChloraPrep™ swabstick (~2.5 in x ~2.5 in)

BD ChloraPrep™ applicators have been designed as convenient single-use, latex-free, hands-off applicators. Designed for a smooth delivery of the appropriate amount of solution for each respective procedure, the packaging for the BD ChloraPrep™ swabstick and the patented glass ampule in the Frepp™, 3 mL, 10.5 mL and 26 mL applicators eliminate the risk of contaminated solution and protect the chlorhexidine gluconate (CHG) molecule from degradation.

Furthermore, BD ChloraPrep™ Frepp™, 3 mL, 10.5 mL and 26 mL applicators each use a patented "wing" design to minimize instances where aseptic technique is compromised.

The tint process for BD ChloraPrep™ Scrub Teal™ and Hi-Lite Orange™ tints is a patented technology that adds color to the solution as it enters the sponge pad. When applied to the skin, each tint allows for easy visualization of the prepped area. Unlike iodine-based preps, which are brown, Scrub Teal™ and Hi-Lite Orange™ tints are easy to see when applied to a variety of skin tones. The dyes in Scrub Teal™ and Hi-Lite Orang™e tints are Food, Drug and Cosmetic (FD&C) Green #3 and Yellow #6 dyes, and have been "generally recognized as safe" (GRAS) by the Food and Drug Administration (FDA). For an ingredient to be listed as GRAS, extensive safety testing is conducted, reviewed and accepted. FD&C Green #3 is a common colorant used in many applications throughout the healthcare field (e.g., eye angiography and screening for ocular dryness, routine lab testing, dye injections, histological/cytological stains for cancer screening of tissues). FD&C Green #3 and Yellow #6 were found to be stable when combined with the 2% chlorhexidine gluconate/70% isopropyl alcohol BD ChloraPrep™ formulation, which offers proven, stable and uncompromised chlorhexidine-based solutions.

It is recommended that BD ChloraPrep™ preoperative skin preparation with tint remain on the skin, especially at the incision site, post-procedure to provide maximum antimicrobial activity. The tints will slowly fade from the skin. If your facility's policies or procedures require clean-up and/or removal of the BD ChloraPrep™ tints, they can be removed with a BD ChloraPrep™ clear applicator, alcohol, or soap and water.

The coverage area is specific to each applicator.

26 mL BD BD ChloraPrep™ applicator: ~13.2 inches x ~13.2 inches

10.5 mL BD BD ChloraPrep™ applicator: ~8.4 inches x ~8.4 inches

3 mL BD BD ChloraPrep™ applicator: ~4 inches x ~5 inches

1mL and FREPP 1.5 mL BD BD ChloraPrep™ applicators and BD ChloraPrep™ swabstick: ~2.5 inches x ~2.5 inches

The BD ChloraPrep™ single and triple swabstick applicators have a two-year shelf life from the date of production. All other BD ChloraPrep™ products are labeled with a three-year shelf life from the date of production.

Yes. The full line of BD ChloraPrep™ applicators is available in a wide range of kits and trays. Our trained customer support representatives can work with your facility kit manufacturers to include BD ChloraPrep™ preoperative skin preparation in your current SPT/CPT kits.

Yes. To request samples, contact BD ChloraPrep™ Customer Support at 1.844.8.BD.LIFE (844.823.5433)

Preoperative skin preparation is necessary to limit microorganisms on the skin and help minimize their entry into an incision or device-insertion site after application. Normal skin flora and suboptimal skin antisepsis are the primary drivers of healthcare-associated infections (HAIs).¹

For most SSIs, the source of pathogens is the endogenous flora of the patient’s skin, mucous membranes, or hollow viscera. When mucous membranes or skin is incised, the exposed tissues are at risk for contamination with endogenous flora.⁴ The goal of preoperative patient skin antisepsis is to reduce the patient's risk of developing a surgical site infection by removing soil and transient microorganisms at the surgical site. Reducing the amount of bacteria on the skin near the surgical Incision lowers the risk of contaminating the surgical incision site. Effective skin antiseptics rapidly and persistently remove transient microorganisms and reduce resident microorganisms to sub-pathogenic levels with minimal skin and tissue irritation.⁵

Surgical skin preparation aims to reduce the bacteria on the skin that may cause infection through the cleaning of the patient’s skin.⁶

Clipping hair before surgery isn’t just messy—the loose hair can increase the potential risk of contamination to your patients. Potentially contaminated hair on linens, wheels and the floor can migrate into the OR and elsewhere in the facility.

Cleaning the skin before surgery reduces the amount of bacteria and microorganisms present that may cause surgical site infections. Follow antiseptic package inserts for optimal efficacy with regards to following prep time, application process, dry time, and warnings/contraindications.

Alcohol-based preoperative skin antiseptics are recommended in the evidence-based infection prevention guidelines published by preeminent health organizations:

● American College of Surgeons/Surgical Infection Society (ACS/SIS): Alcohol-containing preoperative skin preparatory agents should be used unless contraindication exists. (2016)⁷

● Centers for Disease Control and Prevention (CDC): Perform intraoperative skin preparation with an alcohol-based antiseptic agent unless contraindicated. (2017)⁸

● World Health Organization (WHO): The panel recommends alcohol-based antiseptic solutions based on CHG for surgical skin site preparation.⁶

● Society for Healthcare Epidemiology of America (SHEA): Use an alcohol based antiseptic for skin preparation.⁹

○ PVP-I allows for the free iodine to be released, which destroys proteins and DNA of microorganisms.

○ This solution is often used, since it is safe to use on most skin regardless of age.

○ CHG breaks down bacteria cell membranes to disinfect the skin.

○ The combination of fast-acting and persistent antimicrobial

IPA alone provides a 99.99% reduction in bacteria, but it does not provide long-lasting microbial kill. BD ChloraPrep™ maintains antimicrobial activity, demonstrating persistence for at least 7 days¹ compared to two hours for free iodine. Because BD ChloraPrep™ preoperative skin preparation contains the combination of isopropyl alcohol and chlorhexidine, it is more effective than isopropyl alcohol alone.

○ The chlorhexidine bisbiguanide groupings associate strongly to exposed anionic sites on the cell wall and cell membrane, particularly acidic phospholipids and proteins, causing displacement of divalent cations (Ca2+ and Mg2+). Bridging adjacent phospholipids in the cell membrane will cause a loss of structural integrity, reduce membrane fluidity and allow leakage of cellular materials.¹³

○ Bacterial cells are negatively charged, but in the presence of chlorhexidine, the bacterial cell is neutralized and the charge is reversed. The attraction of the cationic chlorhexidine molecule and the negatively charged bacterial cell contributes to a rapid rate of bacterial kill; surface charge reversal is secondary to cell death.³

○ In contrast, traditional iodophors can take two to three minutes until the free release of iodine can occur. While the iodophor dries, free iodine becomes available. The iodine then attacks the bacterial cell and the oxidation of two sulfhydryl groups, resulting in the formation of a disulfide bond. The effectiveness of iodophors is ≤ three hours. Lastly, iodophors are neutralized in the presence of blood and organic matter and have greater irritation than the CHG solution.¹⁴

○ Chlorhexidine-based antiseptics have been used globally for more than 50 years and have been widely used in the US, Europe, Canada and Japan for more than 30 years. In the United States alone, more than 100 studies (excluding those focused on hand hygiene data) have been published, revealing positive outcomes related to the use of chlorhexidine gluconate (CHG)-based antiseptics. There are over 60+ published studies specifically for BD ChloraPrep™ preoperative skin preparation.

The combination of fast-acting and long-lasting antimicrobial activity is the key to an effective preoperative skin preparation. IPA alone provides a 99.99% reduction in bacteria, but it does not provide long-lasting microbial kill. BD ChloraPrep™ maintains antimicrobial activity for at least 7 days¹ compared to two hours for free iodine.³ Because BD ChloraPrep™ preoperative skin preparation contains the combination of isopropyl alcohol and chlorhexidine, it is more effective than isopropyl alcohol alone.

There are a number of reasons why skin preparation prior to surgery matters. Effectively preparing the skin can reduce the microorganisms on the skin that may cause surgical site infections. Below are some of the risk factors:

● On a single square centimeter of skin, there can be as many as 10 million aerobic bacteria¹⁵

● 80% of microorganisms reside in the first five cell layers of the epidermis¹⁶

● Infection prevention measures have focused on asepsis of healthcare providers and the environment, but there is evidence about the role played by the patient's own skin⁸

Skin preparation solutions designed to reduce microorganisms on the skin before surgical procedures may contribute to contamination when nonsterile antiseptic solutions are used. According to the FDA, intrinsic contamination “may occur during the manufacturing process”.¹⁷ Infections from intrinsic contamination of antiseptics have been well documented.¹⁸ ¹⁹ Because of intrinsic contamination risks, the FDA requested that manufacturers label topical antiseptic solutions as sterile or nonsterile.¹⁷ Sterilizing the antiseptic solution during production can minimize potential intrinsic bacterial threats. However, most U.S. manufacturers of commercially available antiseptic skin preparations have not adopted this technologically challenging process. BD overcame this challenge, developing a patented process to sterilize antiseptic solutions within sealed containers to provide sterility assurance. In summary:

● Antiseptics do not self-sterilize ²º

● All commonly used antiseptic agents have been linked to infection-causing contamination.¹⁹

● Outcomes associated with contaminated antiseptics may be underreported for a range of reasons.

Disposal of the contaminated product before infection is discovered¹⁸
Inconsistent contamination within the same product lot¹⁸

BD offers an exclusive portfolio of fully sterile skin prep applicator products.

BD has a number of tools and products aimed at helping reduce bacteria on the skin that may cause infections.

One study compared the removal of dispersed hair using standard surgical clippers with surgical tape vs clippers fitted with the ClipVac™ Hair Removal System. The study assessed clipping duration and the amount of loose hair and microbial contamination following clipping.²¹
- Faster clipping and cleanup time: Using BD clippers with the ClipVac™ System resulted in an average of 40% faster clipping and cleanup time compared to clippers and adhesive tape.
- Reduced contamination: Using clippers and the ClipVac™ System significantly reduced the amount of microbial contamination, by an average of 85%, compared to clipping and tape cleanup.
- Less residual loose hair: Clipping with the ClipVac™ System was highly effective in reducing the dispersion of contaminated hair fibers within areas adjacent to the skin-prep site vs clipping followed by tape cleanup.

● Adhesive tapes, commonly used for hair cleanup, are not sterilized or kept under controlled conditions, and may become colonized with organisms and contribute to HAIs.²²

● The same adhesive tape rolls are frequently used on multiple patients, often containing hair from previous patients.

● AORN guidelines recommend that body hair be removed when it may interfere with surgery, and that hair removal should limit particle dispersion.²³

○ BD’s durable, efficient clippers support patient preoperative hair removal in a single pass and minimize the risk of compromising the skin. Our clippers remove more hair per second than 3M™, Cardinal Health™, and Medline™ in internal laboratory tests²⁴, saving valuable OR patient-prep time. They also offer the following benefits:

A close cut while maintaining skin integrity
A 40° angled, ergonomic handle, allowing seamless preoperative hair removal
Usability in either wet or dry clipping conditions
The only IXP-7 waterproof-rated clippers for submersibility, to support thorough cleaning and disinfecting
Lithium-ion battery technology to facilitate longer runtime and improve energy efficiency
Battery-life and charging indicators that alert clinicians to charge level
Choice of three blades for a variety of procedures

○ BD ChloraPrep™ is a rapid-acting and persistent preoperative skin preparation. Its proven formulation is available in six unique applicators designed for the right amount of solution for the right procedural area.

○ Advantages of BD ChloraPrep™ preoperative skin preparation include its broad spectrum, rapid-acting and persistent antimicrobial activity (7 days¹) and effectiveness in the presence of blood and organic matter. These advantages are a result of the unique 2% CHG/70% IPA formulation of BD ChloraPrep™ preoperative skin preparation. Chlorhexidine gluconate, a cationic bisbiguanide, works by destroying the bacterial cell membrane and precipitating cell contents. Alcohol denatures cell proteins. As a result, BD ChloraPrep™ preoperative skin preparation provides better broad spectrum, immediate, cumulative and residual antibacterial activity compared to traditional iodophors. ² ³

BD PurPrep™ Patient Preoperative Skin Preparation with Sterile Solution is the first and only fully sterile povidone-iodine (PVP-I) plus isopropyl alcohol (IPA) in applicator form available in the United States.

BD E-Z Scrub™ preoperative surgical scrub brushes are single-packaged brushes impregnated with a wide range of antimicrobial formulations. These formulations include chlorhexidine gluconate (CHG), chloroxylenol (PCMX), and povidone-iodine (PVP-I)

These unique sponges are not only designed to be comfortable and gentle on the skin, they are uniquely formulated to help meet CDC and WHO guidelines for cleaning hands before putting on gloves or contacting patients.²⁵

BD ChloraPrep™ in-service resources

Provide in-service education on using BD ChloraPrep™ skin antiseptic solution

These in-service materials can educate personnel on using ChloraPrep skin antiseptic solution.

BD’s collection of literature on industry and on our offerings gives you information you can use to continue striving for excellence.

Learn more

BD’s collection of videos on industry and on our offerings gives you information you can use to continue striving for excellence.

Learn more

This information only pertains to U.S. solutions.

Beausoleil C, Comstock SL, Werner D, Li L, Eby JM, Zook EC. Antimicrobial persistence of two alcoholic preoperative skin preparation solutions. J Hosp Infect. 2022 Nov;129:8-16.
Hemani ML, Lepor H. Skin preparation for the prevention of surgical site infection: which agent is best? Rev Urol. 2009 Fall;11(4):190-5
Denton GW. Chlorhexidine. Disinfection, sterilization, and preservation. (Edited by S.S. Block, 4th ed) Philadelphia: Lea & Feabiger. 1991. pp. 322–333.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr;27(2):97-132
2021 AORN Guidelines for Perioperative Practice: Patient Skin Antisepsis
WHO 2016 Global guidelines for the prevention of SSIs fact sheet https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/ssi/fact-sheet-skin-web.pdf?sfvrsn=ead06f37_2#:~:text=Surgical%20site%20skin%20preparation%20is,the%20operating%20room%20(OR).
Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KM, Dellinger EP, Ko CY, Duane TM. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017 Jan;224(1):59-74
Berríos-Torres SI, et al; Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017 Aug 1;152(8):784-791.
Yokoe DS,,et al; Society for Healthcare Epidemiology of America (SHEA). A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol. 2014 Aug;35(8):967-77.
AORN. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2013:75-89.
Galvin P. Am J Nurs. 2009;109(12):49-55. doi: 10.1097/01.NAJ.0000365187.47124.c0.
Karpanen TJ, et al. Antimicrob Agents Chemother. 2009;53(4):1717-1719. doi:10.1128/AAC.01289-08.
Gilbert, P. and Moore, L.E. (2005), Cationic antiseptics: diversity of action under a common epithet. Journal of Applied Microbiology, 99: 703-715
Trautner, B. Skin antisepsis kits containing alcohol and chlorhexidine gluconate, or tincture of iodine are associated with low rates of blood culture contamination. Infection Control and Hospital Epidemiology, 2002.
Chen YE, Tsao H. The skin microbiome: current perspectives and future challenges. J Am Acad Dermatol. 2013 Jul;69(1):143-55.
Hendley JO, Ashe KM. Antimicrob Agents Chemother 1991 627-31
https://www.fda.gov/drugs/drug-safety-and-availability/questions-and-answers-fda-requests-label-changes-and-single-use-packaging-some-over-counter-topical
Chang C, Furlong LA. Microbial stowaways in topical antiseptic products. NEngJMed. 2012;367;23:2170-2173. doi: 10.1056/NEJMp1212680.
Weber DJ, Rutala WA, Sickbert-Bennett EE. Outbreaks associated with contaminated antiseptics and disinfectants. Antimicrob Agents Chemother. 2007;51(12):4217-4224.
Berger SA. Pseudobacteremia due to contaminated alcohol swabs. J Clin Microbiol. 1983;18 (4): 974-975.
Edmiston CE Jr, Griggs RK, Tanner J, Spencer M, Seabrook GR, Leaper D. Perioperative hair removal in the 21st century: Utilizing an innovative vacuum-assisted technology to safely expedite hair removal before surgery. Am J Infect Control. 2016 Dec 1;44(12):1639-1644.
Redelmeier, DA, Livesley NJ. Adhesive tape and intravascular-catheter-associated infections. J Gen Intern Med. 1999;14(6):373-375
AORN. AORN Guidelines for Perioperative Practice. 2015. Retrieved on May 20, 2016 at https://www.aorn.org/guidelines
Data on File
2009 WHO Hand Hygiene Guidelines