SKIN PREPARATION OF THE SURGICAL PATIENT Ann Marie McGuiness, CST, CNOR McCann Technical School SR 103 - Operating Room Techniques

PURPOSE to render the operative site as free as possible from transient and resident microorganisms, dirt, and skin oil so the incision can be made through the skin with a minimal danger of infection from this source

COMPONENTS MECHANICAL CLEANSING HAIR REMOVAL SKIN PREP

MECHANICAL CLEANSING

MECHANICAL CLEANSING bathing the evening/morning before surgery with an antimicrobial soap hair should be washed, especially for cases of the head and neck NOTE: abnormal skin irritation, infection, or abrasion on or near the operative site may be a contraindication to the performance of the surgical procedure

HAIR REMOVAL

HAIR REMOVAL breaks in the skin permit the entry and colonization of microorganisms, a potential source of infection hair removal should take place as close to the time of surgery as possible, but not in the OR suite so as to minimize environmental contamination of the room

HAIR REMOVAL an order for hair removal should be written in the Doctor's orders removal techniques include: shaving clippers depilatory cream

SKIN PREP

CONCEPTS mechanical cleansing pressure friction chemical antisepsis

SUPPLIES

SUPPLIES basins for antiseptic soap and/or solution

SUPPLIES applicators usually gauze sponges - not radio-opaque!!! q-tip applicators for hard-to-reach areas

SUPPLIES towels for drying sterile gloves

SUPPLIES pads to collect excess prep solution to prevent pooling of the solutions under the patient during surgery

COMMON PREPPING SOLUTIONS

COMMON PREPPING SOLUTIONS Chlorhexidine gluconate Hibiclense Hibitane tincture

COMMON PREPPING SOLUTIONS Iodine and iodophors povidone iodine - Betadine do not use on patients with sensitivity to shellfish! may cause irritation/burn to skin if warmed

COMMON PREPPING SOLUTIONS Alcohol Isopropyl 70% is flammable - do NOT allow to pool, especially with ESU and LASER cases

COMMON PREPPING SOLUTIONS Hexachlorophine Phisohex Phisoderm

PROCEDURE

PROCEDURE Assemble necessary equipment establish a sterile field

PROCEDURE Pour solutions if not premixed, scrub solutions need to be diluted with sterile water this may be done with sterile gloves donned if the containers are sterile also

PROCEDURE Expose the site to be prepped, making sure that the johnny/ blanket will not become contaminated with prepping solution Place protective pads around the patient to collect excess prepping solution

PROCEDURE Don sterile gloves Wet the applicator with scrub solution open gloving without a gown technique Wet the applicator with scrub solution

PROCEDURE areas included in the prep for each operative procedure

PROCEDURE scrub the skin in a circular motion start at the incision point and work toward the periphery

PROCEDURE Discard the sponge after reaching the periphery and obtain a new one to continue

PROCEDURE Scrub for a minimum of five minutes or according to hospital policy

PROCEDURE Dry the area with a sterile towel by placing the towel and then patting the area, using the cuff to lift the towel off the skin when completed

PROCEDURE Apply paint solution using gauze on sponge sticks working from the incision line to the periphery

SPECIALIZED PREP AREAS

SPECIALIZED PREP AREAS The umbilicus is considered contaminated this should be thoroughly cleaned using separate gauzes, prior to starting the skin scrub

SPECIALIZED PREP AREAS Stomas, skin ulcers, sinuses and open wounds are considered contaminated a one inch area around the opening is left during the prep and that area is cleansed with the last strokes of each sponge

SPECIALIZED PREP AREAS Areas of high microbial counts are considered contaminated and are prepped last with each sponge axilla groin hair line

SPECIALIZED PREP AREAS When prepping perineum the mons pubis is cleansed first then the labia majora the thighs outward the labia minora and vestibule the vagina the rectum

SPECIALIZED PREP AREAS Skin grafts separate preps must be used for the donor and recipient sites the donor site is prepared first

SPECIALIZED PREP AREAS Eyes eyebrows are NEVER shaved! eyelashes may be trimmed with iris scissors covered with vaseline jelly to catch the lashes as they are trimmed

SPECIALIZED PREP AREAS Eyes the orbit is prepped with a drop of iodine solution/saline and irrigated with sterile saline from the nose side to the lateral side lids are prepped with q-tips dipped in solution and blotted on sterile gauze

DOCUMENTATION should include: skin condition hair removal technique prep solutions person performing the prep

SKIN PREPARATION OF THE SURGICAL PATIENT