Surgical Prep

Objectives Know the indications and contraindications of various prep types. Describe prepping patterns for various body sites know where to find guidelines for use of various surgical preps.

The Purpose of the prep is to render the surgical site as free as possible from infectious organisms. That’s it. So you may have to wash it first you may have to shave it first.

Prepping for Prep Hair Removal should as close to the time of surgery as possible without actually being done in the OR Patients are asked to shower the night before surgery and may be given CHG wipes to use at home. If the area is visibly dirty you may want to consider washing it with soap and water prior to the final surgical prep. Consider “contaminated” areas like fingernails, toes, skin fold and the umbilicus. Hair harbors bacteria. If it has to be done in the OR clean it up with tape or a vacuum. Clippers are preferred, cause they don’t cut or irritate the skin. Skin integrity should not be compromised for the sake of hair removal

Types of Prep Chlorhexidine Gluconate (2%) and EtOH(70%) Antibacterial action lasts up to 4 hours Effectiveness decreased by the presence of soaps, rinse thoroughly if pre-washing. Not absorbed through intact skin Ototoxic and an Eye irritant, should no be used on the face. Don’t use on broken skin either

e.g. Chloraprep Flammable while wet 3 minutes to dry May cause irritation on infants <2months Effective area 13.2”x13.2” Duraprep

Types of Prep Betadine (povidine iodine) Works well alone or when combined with soaps Virtually non-irritating to mucous membranes (5% sol’n OK for eye prep) Should be left on skin at least 2 minutes. OK to use on infants >2months

Povidone Iodine Scrub/Paint

Types of Prep Iodine & EtOH e.g. Duraprep Cannot be used on face or in eyes due to alcohol content Does not wash off, use “remover lotion” after case Use with caution on infants <2 months. More like Chloraprep than like iodine.

Types of Prep Hibiclense (CHG) Used in cases of iodine allergy where chloraprep is not possible. Eg, broken skin, mucous membranes. Not necessary to dilute

Types of Prep Castille Soap When you can’t use any other kind of prep due to sensitivities. Comes in concentrated packs Scrub with soapy water and rinse Ok to use in vaginal prep

Prepping Theory Clean  Dirty Start with Surgical site Do not re-do an area If you have to prep 2 areas like a crotch and an abdomen which one do you do first? Armpits, finger, toes, ostomies are all considered dirty. Unless they are the surgical site do them last

Special Cases: Eyes No more than 5% betadine (no soap) Do not clip or shave eyebrows Start from where eyelids meet extend outward Make sure prep contacts eyelashes.

Special Cases: Mouth Usually Peridex, Betadine can be used. Provide toothbrush Mouth cases will always be considered “contaminated Peridex Contains CHG

Quiz: Which Prep? ORIF closed ankle fracture Delayed primary closure of traumatic abdominal wound. Laparoscopic appendectomy Pyloromyotomy on a 6 week old infant Cataract surgery Laparoscopic assisted vaginal hysterectomy Facial laceration on pt with shellfish allergy What if the hyst pt has a shellfish allergy? What if it’s a TAH

Post –Op Do I wash off this prep? Betadine Chrloroprep Duraprep Hibiclense Castille Soap Betadine –Yes Chloraprep- No continues action Dura prep- yes use remover lotion Hibiclense –No you already wiped most of it off Soap- its aleady gone