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

2. 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

3. COMPONENTS
MECHANICAL CLEANSING
HAIR REMOVAL
SKIN PREP

4. MECHANICAL CLEANSING

5. 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

6. HAIR REMOVAL

7. 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

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

9. SKIN PREP

10. CONCEPTS
mechanical cleansing
pressure
friction
chemical antisepsis

11. SUPPLIES

12. SUPPLIES
basins for antiseptic soap and/or solution

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

14. SUPPLIES
towels for drying
sterile gloves

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

16. COMMON PREPPING SOLUTIONS

17. COMMON PREPPING SOLUTIONS
Chlorhexidine gluconate
Hibiclense
Hibitane tincture

18. 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

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

20. COMMON PREPPING SOLUTIONS
Hexachlorophine
Phisohex
Phisoderm

21. PROCEDURE

22. PROCEDURE
Assemble necessary equipment
establish a sterile field

23. 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

24. 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

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

26. PROCEDURE
areas included in the prep for each operative procedure

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

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

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

30. 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

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

32. SPECIALIZED PREP AREAS

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

34. 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

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

36. 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

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

38. 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

39. 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

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

41. SKIN PREPARATION OF THE SURGICAL PATIENT