Surgical Technology Skin Preparation DHJ 6/19/05

Objectives Purpose Preliminary skin prep Skin prep on O.R. table Antiseptic solutions skin prep risks Basic prep general guidelines Contaminated areas Special considerations in specific anatomical areas Skin marking Documentation

Purpose of the skin prep Render surgical site free of transient microorganisms, dirt,oil Minimizes danger of infection from the skin incision

Preliminary preparation of skin Mechanical cleansing Hair removal Razor Degreasing

Patient’s skin prep on O.R. table After pt is anesthetized after Foley catheter insertion after positioning

Patient’s skin prep on O.R. table Only agents approved for use on skin should be used on a patient’s skin disposable kits single use applicators Set up Scrub /paint

Antiseptic solutions Broad-spectrum anti- microbial action /rapid decrease of Microbial count Use with ease Long acting Safe to use on skin w/o irritation or sensitization Non-toxic Remains effective in the presence of alcohol, organic matter, soap, or detergent Non-flammable for use with laser, ESU

Antiseptic agents: Isopropyl Alcohol Advantages: 95% effective against gram - and gram + bacteria, mycobacteria, fungi, and viruses available in liquid or gel preparations can be combined with other antiseptic agents Disadvantages: not completely effective against bacterial spores extremely flammable not used on mucous membranes, eyes, or open wounds

Antiseptic Agents: Chlorhexidine Gluconate (CHG) Advantages: provides residual activity not absorbed by skin used for pre-op bathing as a “final wash” Disadvantages: contraindicated for facial asepsis (eyes), large open wounds, or burns linked to hearing loss if used in the middle ear not effective in the presence of soap, organic debris (skin oils, blood, body fluids)

Antiseptic agents: Iodophor (iodine mixed with povidone) (betadine) Advantages: effective against gram-positive bacteria provides residual activity retains microbial action in the presence of organic debris available in solutions, sprays, or gel preparations Disadvantages: iodine used alone is a major irritant weak against myco-bacteria, fungi, viruses absorbed into skin; may cause toxicity can cause 1st/2nd degree burns

Antiseptic agents: Triclosan Advantages: commonly found in deodorants and soaps safe for ophthalmic use and use on face Disadvantages: limited use due to short acting effectiveness-must repeat application continuously to provide effective microbial effect

Antiseptic agents: Parachlorometaxylenol (PCMX) Advantages: non-toxic safe for use on eye area, ears Disadvantages: weak against myco- bacteria, fungi, viruses

Pt risks related to surgical skin prep Chemical burn Fire Dislocation/fracture Injury from warming solution Pooling

Skin prep general guidelines Gather supplies prior to procedure sterile, not clean ALLERGY ALERT do not use radiological detectable surgical sponges do not use kick bucket as a trash can

Contaminated areas Umbilicus:

Contaminated areas Stoma:

Contaminated areas Ulcers, sinuses, vagina, anus:

Contaminated areas Foreign bodies

Contaminated areas Traumatic wounds:

Contaminated areas Areas to be grafted: prep donor site first use a colorless prep use separate prep kits

Special considerations in specific anatomical areas Eyes Ears, Face, nose Neck Chest/breast Shoulder Upper arm Elbow/ forearm Hand Lateral Thoracoabdomi nal hip thigh Knee/lower leg ankle/foot Rectoperineal Vagina

Skin marking Usually done prior to prep skin marker used after prep must be sterile Ethylene blue Alcoholic gentian violet

Incise Drape

Documentation Details of preoperative skin preparation and prep condition of skin and surgical site hair removal, method, location, areas for attachment of monitors, time of removal Antiseptic solutions, fat solvents, irrigation solutions used name of person who preformed prep