1. Prepping
The surgical skin prep is performed on the surgical patient for the same reasons that the sterile surgical team members perform the surgical scrub prior to entry into the sterile field.

2. WHY?? To remove transient organisms from the patient’s skin
To reduce the number of resident organisms on the patient’s skin

3. To shave or NOT to shave?
Hair removal, does it interfere with the electrode placement, the surgical site, wound closure and dressing application
It may be removed according to surgeon’s preference, facility policy, age and gender of the patient, and the planned operative site

4. Hair removal continued…..
Shave as close as possible to the planned procedure to reduce the risk of microbial growth in any breaks in the skin
Be sure that the privacy of the awake patient is ensured to avoid embarrassment during the process

5. Other Factors related to the Skin Prep
All necessary procedures must be carried out prior to performing the surgical skin prep
Anesthesia administration
Foley Catheterization
Positioning
Exposure of surgical site
Hair removal
Skin Marking

6. Gross soil & skin oils must be removed from the planned operative site:
May require use of a fat solvent or degreaser
May require us of a scrub brush and/or nail cleaner

7. Prep Fluids
May NOT be allowed to accumulate adjacent to or under the patient
May cause a chemical irritation
Increased the risk of ESU or Laser burn
Consider the patient’s allergy status prior to application

8. Certain Contaminated areas:
May require special attention
General rule: prepping the surrounding areas first and the contaminated areas last and to use a separate sponge for each area.
Exceptions:
Mucous membranes
Stomas
Nonintact skin
Sinus tracts
Umbilicus

9. Some more prepping considerations..
Two separate skin preps may be necessary in certain situations
Prep is initiated at eh planned incision site and carried toward the periphery (circular motion)
An assistant may be necessary to hold a limb that must be circumferentially prepped
Recommendations of the antiseptic manufacturer must be followed
Preoperative skin markings are not removed during the surgical skin prep

10. NOTE********
Some of the preparatory steps may also apply to the skin sites selected for placement of the dispersive electrodes for the ESU and the ECG electrodes

11. Types of Skin Solutions used in the OR
Alcohol: Rapid and significant reduction in skin microbial counts
Iodophors: Less likely to cause skin irritation and do not need to be removed
Chlorhexidine: Does not provide as rapid a reduction in skin microbial couns as alcohol, but provides longer residual effects (5-6 hours)

12. Several Products Available:
Scrub soaps
Scrub solutions
Single-use prep applicators (emergency C-Section)
These agents used should be a broadspectrum antimicrobial and should provide residual protection. The agent chosen for use should be based on the particular patient and skin sensitivity

13. NOTE…………..
The items necessary for final skin preparation should be arranged on a separate sterile Mayo stand or prep stand. Prep packs are available in sterile form, containing all the necessary equipment except for the antiseptic scrub solution and “Paint” soulution.

14. Single Use Applicators
Alcohol based antiseptic solution that leaves an antimicrobial film.
Self contained units (need to be activated)
Shown to have long lasting antimicrobial effect
Leave an antimicrobial film on the skin

15. PREPS!! Abdominal and Thorcoabdominal Chest and Breast
Eyes, Ears, Face and Nose
Extremities
Perineal and Vaginal Preps
Please see pages Skin prep perimeters

16. Preps to be practiced in the LAB
Laparotomy - Supine
Knee arthroscopy – Supine (extremity)
Nephrectomy – Kidney (right or left) depends on which side patient is laying…
Vaginal hysterectomy - Lithotomy