| Course | NR 449 Evidence Based Practice |
|---|---|
| Week | 3 |
| Paper type | Evidence summary |
| Length | About 1,120 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 449 Week 3
Alcohol-Based Skin Antisepsis Before Surgery: An Evidence Summary and a Sufficiency Verdict for an Ambulatory Surgery Center
Student Name
College of Nursing, Chamberlain University
NR 449: Evidence Based Practice
Instructor Name
Month Day, Year
Alcohol-Based Skin Antisepsis Before Surgery: An Evidence Summary and a Sufficiency Verdict for an Ambulatory Surgery Center
The Practice and the Question
The composite ambulatory surgery center described in the previous week's practice problem statement prepares the skin of most adult surgical patients with an aqueous povidone-iodine scrub and paint, a routine chosen years ago and never revisited. Its surgical site infection rate for clean-contaminated procedures is within the range its surgeons consider acceptable, but the center's quality committee has asked whether the preparation should change. This summary answers one question: is enough known about alcohol-based skin antisepsis, compared with aqueous povidone-iodine, to stop reading and change the practice?
The question matters for nursing because skin preparation is performed, timed and documented by perioperative nurses at this center, and the nurses' practice council, not the surgeons, owns the preparation protocol. The center performs about 4,200 procedures a year, most of them general surgery, gynecology and orthopedics. It tracks surgical site infections through a 30-day phone call and surgeon report, and it recorded 23 infections last year, a rate the committee believes is an undercount because some patients present to other facilities.
What the Evidence Supports
The evidence supports preparing surgical skin with an antiseptic that contains alcohol, and it supports that claim with reasonable consistency. The most influential trial randomized 849 adults having clean-contaminated abdominal, thoracic, gynecologic or urologic surgery at six hospitals to chlorhexidine in alcohol or aqueous povidone-iodine and found surgical site infection in 9.5 of every 100 patients in the chlorhexidine-alcohol group and 16.1 of every 100 in the povidone-iodine group, with the difference driven by fewer superficial and deep incisional infections (Darouiche et al., 2010). A later randomized trial of 1,147 women having cesarean delivery found infection in 4.0 of every 100 women prepared with chlorhexidine-alcohol and 7.3 of every 100 prepared with iodine-alcohol (Tuuli et al., 2016). A Cochrane review of skin antiseptics for clean surgery found some evidence favoring chlorhexidine in alcohol but judged the overall certainty of comparisons between agents to be low, largely because the trials were small or at risk of bias (Dumville et al., 2015).
Where the Studies Disagree
The main disagreement is about which alcohol-based agent is best, not about whether alcohol helps. The trial by Darouiche et al. (2010) compared chlorhexidine in alcohol with povidone-iodine in water, so it cannot separate the effect of chlorhexidine from the effect of alcohol. A prospective study at one academic hospital that rotated three preparation protocols over time found the lowest infection rate with an iodine povacrylex preparation in isopropyl alcohol, not with chlorhexidine-alcohol (Swenson et al., 2009). That study was not randomized, and a change in infection rates across time periods could reflect other changes in practice. The cesarean trial compared two alcohol-based agents and favored chlorhexidine (Tuuli et al., 2016). Taken together, the most consistent reading is that alcohol-based preparations as a group outperform aqueous povidone-iodine, while the comparison between chlorhexidine-alcohol and iodine-alcohol remains less settled.
There is a second, quieter disagreement about the size of the benefit. The absolute difference in the Darouiche trial, more than six infections prevented per 100 patients, came from a population with a high baseline rate after clean-contaminated surgery. In lower-risk clean procedures, the Cochrane authors could not confirm a clear difference between agents, partly because infections were too rare in the trials to detect one (Dumville et al., 2015). The direction of effect appears consistent, but its size depends heavily on the baseline risk of the procedure.
What a National Body Has Said
The question has been answered by a national guideline. The 2017 federal guideline on preventing infection at the surgical site recommends performing intraoperative skin preparation with an alcohol-based antiseptic agent unless contraindicated, as a strong recommendation based on high-quality evidence (Berríos-Torres et al., 2017). The guideline does not specify chlorhexidine over iodine within the alcohol-based group. Because a professional body has already weighed this evidence, the center does not need to reargue the core question; it needs to decide which alcohol-based agent fits its procedures and how to use it safely.
What the Evidence Does Not Contain
The trials establish that alcohol-based preparation reduces infection under trial conditions, in hospital operating rooms, for clean-contaminated abdominal surgery and cesarean delivery. They do not contain three things the center needs. First, they do not report results for short ambulatory procedures, such as hernia repair and laparoscopic cholecystectomy, which make up most of the center's cases and carry lower baseline infection rates, so the absolute benefit here may be smaller. Second, they do not address the fire risk that alcohol-based preparations carry if the skin is not allowed to dry before drapes go on and electrosurgical devices are used, which is a real operating room hazard and a matter of technique rather than of evidence about infection. Third, they do not address mucous membranes or the eye area, where alcohol-based agents are contraindicated and povidone-iodine will still be used.
What This Means for the People Who Do the Work
Adopting an alcohol-based agent changes the perioperative nurse's work in specific ways that the evidence summary should name even though it does not resolve them. Alcohol-based agents must dry completely before drapes are applied, which takes about three minutes for most products and longer in skin folds or hair, and pooling of the solution under the patient or on linens must be prevented because of fire risk. The nurse becomes responsible for timing the drying period, which means that the room's pace must allow it. Staff will need to know which areas cannot receive an alcohol-based agent and when to use the povidone-iodine that will remain stocked. These are exactly the questions a practice change proposal must answer, and they are the reason the verdict above sends the center to proposal writing rather than to more reading.
The Sufficiency Verdict
Enough is known to stop reading and change the practice. The center should adopt an alcohol-based skin preparation, chlorhexidine-alcohol or iodine-alcohol, as its standard for intact skin, with aqueous povidone-iodine kept only for mucous membranes and for patients with a documented chlorhexidine allergy. The remaining uncertainty, which alcohol-based agent is best, is not a reason to delay, because both outperform the current practice and the national guideline recommends the class rather than a product. The questions the evidence leaves open, drying time, fire safety and application technique, are implementation questions, and they belong in the change proposal rather than in further reading.
References
Berríos-Torres, S. I., Umscheid, C. A., Bratzler, D. W., Leas, B., Stone, E. C., Kelz, R. R., Reinke, C. E., Morgan, S., Solomkin, J. S., Mazuski, J. E., Dellinger, E. P., Itani, K. M. F., Berbari, E. F., Segreti, J., Parvizi, J., Blanchard, J., Allen, G., Kluytmans, J. A. J. W., Donlan, R., . . . Schecter, W. P. (2017). Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surgery, 152(8), 784-791. https://doi.org/10.1001/jamasurg.2017.0904
Darouiche, R. O., Wall, M. J., Jr., Itani, K. M. F., Otterson, M. F., Webb, A. L., Carrick, M. M., Miller, H. J., Awad, S. S., Crosby, C. T., Mosier, M. C., AlSharif, A., & Berger, D. H. (2010). Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. New England Journal of Medicine, 362(1), 18-26. https://doi.org/10.1056/NEJMoa0810988
Dumville, J. C., McFarlane, E., Edwards, P., Lipp, A., Holmes, A., & Liu, Z. (2015). Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database of Systematic Reviews, 2015(4), Article CD003949. https://doi.org/10.1002/14651858.CD003949.pub4
Swenson, B. R., Hedrick, T. L., Metzger, R., Bonatti, H., Pruett, T. L., & Sawyer, R. G. (2009). Effects of preoperative skin preparation on postoperative wound infection rates: A prospective study of 3 skin preparation protocols. Infection Control & Hospital Epidemiology, 30(10), 964-971. https://doi.org/10.1086/605926
Tuuli, M. G., Liu, J., Stout, M. J., Martin, S., Cahill, A. G., Odibo, A. O., Colditz, G. A., & Macones, G. A. (2016). A randomized trial comparing skin antiseptic agents at cesarean delivery. New England Journal of Medicine, 374(7), 647-655. https://doi.org/10.1056/NEJMoa1511048
The Chamberlain NR 449 Week 3 instructions
The Week 3 summary has you summarize and appraise the evidence for a practice change and decide whether it is sufficient. The checklist generally covers the practice and question, what the evidence supports, where studies disagree, relevant guidelines, gaps in the evidence for your setting, implications for staff and a verdict, in APA. State the claim before naming any study, at the strength the designs will bear. Put studies inside sentences with their numbers. Name disagreements and explain them from the papers. Report what national bodies have said. List what the evidence does not cover for your setting. Name how the change would affect the people doing the work. End with one verdict.
How the NR 449 Week 3 example is put together
The first section describes the center's current skin preparation and explains that the nurses' practice council decides it. The next section states that alcohol-based preparation reduces infection and cites Darouiche and colleagues' trial and Tuuli and colleagues' cesarean trial with their figures. The disagreement section explains that Darouiche compared chlorhexidine in alcohol with aqueous povidone-iodine, so it could not separate chlorhexidine from alcohol, and notes Swenson and colleagues' nonrandomized comparison. The guideline section reports the federal recommendation for an alcohol-based agent. The gaps section notes that trials were in hospital operating rooms, not ambulatory centers. The staff section covers drying time and fire safety. The verdict adopts chlorhexidine-alcohol or iodine-alcohol.
NR 449 Week 3 rubric: what full points look like
Evidence summary rubrics in NR 449 usually score a clear question, accurate synthesis of evidence, handling of disagreement, use of guidelines, identification of gaps, implications for practice, a sufficiency judgment and APA. The sufficiency verdict is the row this course cares about most, and the paper earns it by stating plainly that the reading is finished. Synthesis is credited because the claim leads and studies support it with numbers. Disagreement scores when each conflict is explained from the papers' designs. Guidelines earn points through the federal recommendation of a class rather than a product. Gaps are credited for being specific to an ambulatory setting. Five references, including two randomized trials and a Cochrane review, complete APA.
NR 449 Week 3 help: mistakes that cost points
The heaviest loss on this summary is ending without a verdict, closing on further research and leaving an implementation course with nothing to implement. Another is listing studies one per paragraph instead of making a claim. Students also hide disagreements, overstate the size of benefits or ignore what the evidence does not cover in their setting. Five to eight sources are usually enough. If the evidence turns out to be thin, say so and adjust the verdict. This is not the same as a synthesis in a research course; it ends in a decision. If you have a practice question, send it and an NR 449 evidence summary can be built to a clear verdict.
Get a NR 449 Week 3 example written to your instructions
Send the Week 3 instructions along with your practice statement and whatever sources your section requires, and a custom example is written as a summary of that evidence and returned inside 24 to 48 hours. The first one is free. Which studies belong in it, and which get left out, remains your judgment to make.
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- NR 449 Week 8: Dissemination Brief
- NR 451 Week 3: Literature Review
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NR 449 Week 3 questions, answered
How many sources does the summary need?
Whatever your section names, and the count matters less here than the verdict does. Four sources pointing the same way, reported with their conditions attached, support a decision better than ten summarized in turn. Where a minimum is set, meet it, then spend the remaining space on consistency and sufficiency rather than on another paragraph of description.
What if the evidence turns out to be thin?
Then say so, and the summary gets easier rather than harder. A verdict of not yet is a real result and it changes what the following weeks propose: a smaller trial of the change, a tighter measure, or a decision to leave the routine alone for now. What loses marks is thin evidence written up as though it were firm.
Is this the same as a synthesis?
Close in method and different in purpose. A synthesis asks what the literature establishes and stops at that. This one asks whether what it establishes is enough to justify disturbing a working routine, which is a judgment about action rather than about the literature, and it is the judgment your section is grading.
Where can I find a free NR 449 Week 3 sample paper?
The complete Week 3 summary on alcohol-based surgical skin antisepsis, with the claim, studies, disagreements, the national guideline, gaps, staff implications, the verdict and five references, can be read here.
What verdict does the NR 449 Week 3 summary reach?
That enough is known to change practice: the center should adopt chlorhexidine-alcohol or iodine-alcohol for intact skin and keep aqueous povidone-iodine for mucous membranes and documented chlorhexidine allergy.