1. Skin Preps

2. Objectives State the rationale for performing skin preps.
Identify different types of prepping agents and the indications and contraindications for each.
Identify the prepping procedure for common types of surgery.
List the components to be included in the documentation of skin preps.

3. Skin Layers
Epidermis- made up of stratified squamous epithelium and constantly shedding.
Dermis-Contains Collagen, elastin, hair follicles sweat glands, sebaceous glands, blood and lymph vessels and nerves.

4. Purpose
Remove soil, debris, skin oils, lotions, transient microorganisms
Decrease microorganism count on the skin
Suppress the growth of microorganism population during surgery
Reduce the hazard of microbial contamination by skin flora at the surgical site

5. Microorganisms
E-coli
Transient –organisms that are acquired through direct contact-attached loosely-removed by mechanical means
Resident – organisms living below skin in hair follicles, sebaceous glands and sweat glands-reduced and neutralized by the antimicrobial agent
Increased numbers of microorganisms in folds and wrinkles on skin
The individual person is the primary source of nosocomial bacteria in the operative setting.
Requires mechanical action & chemical agents to eliminate and prevent re-growth.

6. Principals of Skin Preps
Skin is a major source of microbial contamination.
Skin can never be sterilized.
Transmission of microbes can cause an infection.
Goals of surgical skin preps
Remove soil and transient organisms
Reduce resident microbial count
Inhibit rapid rebound regrowth

7. Agents Soaps-a cleansing and emulsifying agent
Detergents-preparations that are chemically different from soaps but are able to emulsify oils
Antimicrobial agents-destroying or inhibiting the growth of microorganisms

8. Antimicrobial Agents Broad spectrum-kills wide range of organisms
Persistent-maintenance of effectiveness over a long period of time
Nonirritating
Nontoxic
Fast acting
Always follow manufacturer’s recommendations for application.

9. Antimicrobial Agents Chlorhexidine Gluconate (CHG)
ChloraPrep – GHG & Alcohol
Hibiclens – CHG & Alcohol
Iodophors (Betadine)
Alcohol
PCMX- (Technicare)

10. Chlorhexidine Gluconate
Hibiclens™- 4% CHG & 4% alcohol
ChloraPrep™ - 2% CHG & 70% alcohol
Actions
Disrupts cell membranes-kills fungus, bacteria & viruses
Prevents regrowth for six hours
Alcohol component acts as a degreaser
Designed for topical skin application
Cautious use above the neck
Avoid eyes, ears, mucous membranes, nerve and meningeal tissues

11. Iodophors Invades cell walls and replaces with iodine
Betadine : scrub & paint
Invades cell walls and replaces with iodine
Kills fungus, bacteria
Limited duration of action
Safe on mucous membranes
Contraindications: Not for use on patients with allergies to iodine

12. PCMX-Technicare™ Contains 3.00% chloroxylenol
Kills gram positive and gram negative bacteria
Has good persistance
Safe and effective for mucous membranes and around ears and eyes.

13. Alcohol
70% Isopropyl
Alcohols are effective against most gram positive and negative bacteria, as well as most fungi and viruses.
Does not have persistant action
Use as a degreaser
Used with other agents (such as Chlorhexidine to add persistence).
Flammable

15. Procedure Assessment Surgical site Integrity of skin
Patient allergies to solutions

16. Procedure Preoperative cleansing Preoperative shower
Preoperative wash of surgical site
If patient obviously dirty and there is time (no threat of life or limb), take a scrub brush and do a pre wash of the surgical site.

17. Procedure Hair removal Outside of the operating room suite (optimal)
As close to the time of surgery as possible
Clippers (method of choice)

18. Abdominal Procedure (2 solutions)
Abdominal skin prep – two solutions (betadine scrub & paint or Hibiclens & alcohol)
Verify incision site.
Explain procedure (if patient is awake).
Determine area to be prepped.
Expose only the area to be prepped.

19. Abdominal Procedure (2 solutions)
Hold sponge by wings
Abdominal prep
Open prep set.
Don sterile gloves and prepare the prep set.
Place sterile towels on either side of the patient’s body.
Solution 1:
Use cotton-tipped applicators to swab out umbilicus.
Hold sponge by wings or wrap gauze around fingertips - squeeze out excess solution.

20. Abdominal Procedure (2 solutions)
Abdominal prep (solution 1 continued)
Begin at the site of the incision and work outward.
Discard used sponges - use new ones whenever returning to the incision site.

21. Blotting Abdominal Procedure (2 solutions)
Blotting procedure-
place towel on site
blot area prep
remove towel from far side, careful not to drag edges across prep area

22. Abdominal Procedure (2 solutions)
Abdominal prep
Solution 2 procedure: Begin at the incision site and use an outward circular motion to cover the scrubbed area. Repeat with a second sponge stick.
Carefully remove runoff towels, discard prep materials.
Allow to air dry.

23. ChloraPrep - Procedure
Place ChloraPrep applicator and cotton tip applicators on sterile field.
Hand to scrub or set up sterile table.
Don Sterile gloves
Place drip sheets.
Pinch lever once until ampules break.

24. ChloraPrep - Procedure
Swab umbilicus with cotton-tipped applicators.
Press applicator against treatment area to evenly distribute solution in the sponge.
Start at incision site in back and forth motion for 30 seconds.
Continue to work outward to the peripheral area.
Remove drip sheets - do not blot.
Allow to air dry.
Discard the applicator after single use.

25. VARIATIONS: VAGINAL PREP
Choose appropriate agent.
Place drape under patient’s buttocks.
Prep thighs to pubis.
Prep perineum from pubis to anus.
Prep vaginal vault.

26. VARIATION: EXTREMITIES
Start at incision site and move away, circumferentially.
Shoulders and upper arms
Knees and lower legs
Hands and feet

27. PEDIATRIC CONSIDERATIONS
Children have difficulty maintaining normothermia
Caution when using warming measures

28. DOCUMENTATION Condition of the patient’s skin Hair removal
Prepping agent(s) used
Area of body prepped
Person(s) performing the prep
Development of any reaction