Best evidence statement (BESt) Safe use of iodine-based skin preparation products in the perioperative area among patients with known or stated food allergy to shellfish or fish

The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).

An implementation strategy was not provided.

Not stated

This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document. This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.

Search Strategy

• Databases: MEDLINE, CINAHL , Cochrane Database of Systematic Reviews, Google Scholar
• Search Terms: Iodine sensitivity/allergy, seafood sensitivity/allergy, fish sensitivity/allergy, hypersensitivity, povidone-iodine, betadine, immunology
• Limits and Filters: None
• Search Dates: Default date parameters were used for each database (date parameters not limited).
• Date Last Search Done: June 25, 2012

A total of five articles were found which addressed the clinical question, including one systematic review, two descriptive studies and three expert opinion articles.

Table of Evidence Levels

†a = good quality study; b = lesser quality study

Not stated

Not stated

A formal cost analysis was not performed and published cost analyses were not reviewed.

This Best Evidence Statement has been reviewed against quality criteria by two independent reviewers from the Cincinnati Children's Hospital Medical Center (CCHMC) Evidence Collaboration.

Not applicable: The guideline was not adapted from another source.

Cincinnati Children's Hospital Medical Center

Not stated

Author: Leslie Knepper BSN, CNOR, Registered Nurse III-Liberty Perioperative Services

Support/Consultant: Carolyn Smith MSN, RN, Evidence Based Practice Mentor, Cincinnati Children's-Center for Professional Excellence, Research & EBP; Mary Ellen Meier MSN, RN, CPN, Evidence-Based Practice Mentor-Center for Professional Excellence and Business Integration

Ad Hoc/Content Reviewers: Carrie Romano MSN,RN, CNL, CPN, Education Specialist, Cincinnati Children's Liberty Perioperative Services; Lisa Phipps, BSN,RN, CNOR, CPN, Clinical Manager, Cincinnati Children's Liberty Perioperative Services

Conflict of interest declaration forms are filed with the Cincinnati Children's Hospital Medical Center Evidence-based Decision Making (CCHMC EBDM) group. No financial conflicts of interest were found.

This is the current release of the guideline.

Electronic copies: Available from the Cincinnati Children's Hospital Medical Center.

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

The following are available:

• Judging the strength of a recommendation. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2008 Jan. 1 p. Available from the Cincinnati Children's Hospital Medical Center Web site.
• Grading a body of evidence to answer a clinical question. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 1 p. Available from the Cincinnati Children's Hospital Medical Center Web site.
• Table of evidence levels. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2008 Feb 29. 1 p. Available from the Cincinnati Children's Hospital Medical Center Web site.

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

In addition, suggested process or outcome measures are available in the original guideline document.

None available

This NGC summary was completed by ECRI on January 24, 2013. This summary was updated by ECRI Institute on March 6, 2014 following the U.S. Food and Drug Administration advisory on Over-the-Counter Topical Antiseptic Products.

This NGC summary is based on the original full-text guideline, which is subject to the following copyright restrictions:

Copies of this Cincinnati Children's Hospital Medical Center (CCHMC) Best Evidence Statement (BESt) are available online and may be distributed by any organization for the global purpose of improving child health outcomes. Examples of approved uses of the BESt include the following:

• Copies may be provided to anyone involved in the organization's process for developing and implementing evidence based care
• Hyperlinks to the CCHMC website may be placed on the organization's website
• The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or electronic documents
• Copies may be provided to patients and the clinicians who manage their care

Notification of CCHMC at EBDMInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.

To evaluate, among patients with a known or stated food allergy to shellfish or fish, if using iodine-based products prior to a surgical procedure increases the risk for experiencing an allergic reaction

Patients who require skin preparation prior to a surgical procedure and have a known or stated food allergy to shellfish or fish

Use of iodine-based skin preparation products prior to surgical procedures

Risk for experiencing an allergic reaction

The strength of the recommendation (strongly recommended, recommended, or no recommendation) and the quality of the evidence (1a‒5b) are defined at the end of the "Major Recommendations" field.

It is recommended that all patients receive skin preparation products using iodine-based medical products prior to surgical procedures, as appropriate (Schabelman & Witting, 2010 [1b]; Beaty, Lieberman, & Slavin, 2008 [4a]; Coakley & Panicek, 1997 [5a]; Katelarius, 2009 [5a]; Lieberman, 2012 [5a]).

Note: Patients with known or stated food allergy to shellfish or fish may not have a higher risk of experiencing an allergic reaction to iodine-based products (Schabelman & Witting, 2010 [1b]; Beaty, Lieberman, & Slavin, 2008 [4a]; Huang, 2005 [4a]; Coakley & Panicek, 1997 [5a]; Katelarius, 2009 [5a]; Lieberman, 2012 [5a]).

Definitions:

Table of Evidence Levels

†a = good quality study; b = lesser quality study

Table of Language and Definitions for Recommendation Strength

Note: See the original guideline document for the dimensions used for judging the strength of the recommendation.

None provided