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SKIN PREPARATION OF THE SURGICAL PATIENT
Ann Marie McGuiness, CST, CNOR McCann Technical School SR Operating Room Techniques
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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
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COMPONENTS MECHANICAL CLEANSING HAIR REMOVAL SKIN PREP
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MECHANICAL CLEANSING
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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
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HAIR REMOVAL
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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
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HAIR REMOVAL an order for hair removal should be written in the Doctor's orders removal techniques include: shaving clippers depilatory cream
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SKIN PREP
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CONCEPTS mechanical cleansing pressure friction chemical antisepsis
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SUPPLIES
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SUPPLIES basins for antiseptic soap and/or solution
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SUPPLIES applicators usually gauze sponges - not radio-opaque!!!
q-tip applicators for hard-to-reach areas
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SUPPLIES towels for drying sterile gloves
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SUPPLIES pads to collect excess prep solution to prevent pooling of the solutions under the patient during surgery
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COMMON PREPPING SOLUTIONS
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COMMON PREPPING SOLUTIONS
Chlorhexidine gluconate Hibiclense Hibitane tincture
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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
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COMMON PREPPING SOLUTIONS
Alcohol Isopropyl 70% is flammable - do NOT allow to pool, especially with ESU and LASER cases
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COMMON PREPPING SOLUTIONS
Hexachlorophine Phisohex Phisoderm
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PROCEDURE
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PROCEDURE Assemble necessary equipment establish a sterile field
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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
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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
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PROCEDURE Don sterile gloves Wet the applicator with scrub solution
open gloving without a gown technique Wet the applicator with scrub solution
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PROCEDURE areas included in the prep for each operative procedure
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PROCEDURE scrub the skin in a circular motion
start at the incision point and work toward the periphery
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PROCEDURE Discard the sponge after reaching the periphery and obtain a new one to continue
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PROCEDURE Scrub for a minimum of five minutes or according to hospital policy
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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
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PROCEDURE Apply paint solution using gauze on sponge sticks
working from the incision line to the periphery
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SPECIALIZED PREP AREAS
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SPECIALIZED PREP AREAS
The umbilicus is considered contaminated this should be thoroughly cleaned using separate gauzes, prior to starting the skin scrub
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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
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SPECIALIZED PREP AREAS
Areas of high microbial counts are considered contaminated and are prepped last with each sponge axilla groin hair line
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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
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SPECIALIZED PREP AREAS
Skin grafts separate preps must be used for the donor and recipient sites the donor site is prepared first
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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
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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
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DOCUMENTATION should include: skin condition hair removal technique
prep solutions person performing the prep
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SKIN PREPARATION OF THE SURGICAL PATIENT
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