1. Surgical Prep

2. 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.

3. 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.

4. 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

5. 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

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

7. 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

8. Povidone Iodine Scrub/Paint

9. 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.

10. 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

11. 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

12. 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

13. 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.

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

15. 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

16. 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