1. Surgical Technology Lecture Series 2000©
Power-Point®

2. Skin Preparation - Part I
Surgical Prep
Prior to Draping

3. Production Notes Author - Kevin Frey CST, MA
Series Editor - Teri Junge, MEd, CSFA, CST, FAST

4. Table of Contents Purposes of the Skin Prep Prep Tray
Antiseptic Solutions
General Skin Prep Procedure
Important Notes
Contaminated Areas
Preparation for Skin Graft

5. Purposes of the Skin Prep

6. Purposes Remove soil, dirt, and debris Remove natural skin oils
Remove residue from hand lotions
Remove transient microbes from the skin
Decrease the number of resident microbes on the skin

7. Purposes (continued)
Suppress the growth of microbes during the surgical procedure
Reduce possibility of contamination of the surgical wound by skin flora
Remember
The skin prep is similar to the surgical scrub - using both mechanical and chemical action

8. Prep Tray

9. Prep Tray
Assorted types of prep trays with different configurations are available commercially
Commercial tray may include the following
Wrapper that will be used to create the sterile field on the prep stand
Two absorbant towels for blotting the prep solution
Packets containing pre-measured prep solutions (scrub and paint)

10. Prep Tray (continued) Commercial Tray Contents (continued)
Two cotton tip applicators (to clean the umbilicus)
Two to four foam sponges on a stick
Four to six winged sponges
Two absorbant towels with barrier to prevent pooling of solution under body parts or along side of patient
Pair of sterile gloves

11. Prep Tray (continued) Remember
Verify patient’s allergy status prior to application of antiseptic prep solution
Prep tray may be placed warmer to heat solutions (according to facility policy)
Inform the awake patient that prep will begin and let them know that the solution may be cold
Extra antiseptic solution(s) may be added to the tray if needed
As a courtesy, if time permits, the STSR may organize the contents of the prep tray for the circulator

12. Antiseptic Solutions

13. Chlorhexidine Gluconate
Popular commercial name is Hibiclens®
Effective against gram positive and gram negative microbes
Damages cell wall
Rapid acting
Produces immediate and effective reductions of transient and resident flora

14. Chlorhexidine Gluconate (continued)
Long lasting effects
Maintains reduction of microbes 4-5 hours
Rarely irritating to skin
Contraindicated for use on the face
May cause corneal damage
Few people allergic

15. Iodophor Iodine mixed with a detergent solution
Referred to as Povidone-iodine solution
Popular commercial name is Betadine®
Effective against gram positive and gram negative microbes
Some sporicidal activity

16. Iodophor (continued) Some residual effect Slowly releases iodine
Higher incidence of persons allergic to solution due to iodine allergy
Available as scrub and paint solution, and in spray or gel forms

17. Alcohol Ethyl or isopropyl alcohol No residual activity
Available 60% to 90% concentrations
Most common is 70%
No residual activity
Denatures the protein to kill the cell
Cannot be applied to mucous membranes or open wounds

18. Alcohol (continued) Nontoxic Dries the skin Flammable
Must not be allowed to pool around or under patient
Must be allowed to dry before draping to prevent build-up of fumes under the drapes if cautery or laser will be used

19. General Skin Prep Procedure

20. Procedure Position and expose patient
Be sure edge of blanket and gown are folded back from site in a sufficient manner
If surgery is unilateral, make sure you check patient chart to ensure correct side or extremity is prepped
Check preoperative orders
Surgeon may have written orders concerning the skin prep

21. Procedure (continued)
Note the condition of the patient’s skin
Abnormal skin irritations, abrasions, bruises, or infection should be noted
Document any conditions in the intraoperative record
Notify the surgeon before beginning the prep
Open the sterile prep tray
Provide adequate lighting

22. Procedure (continued)
Don the sterile gloves using the open glove technique
Organize contents of prep tray
Open packets of scrub and paint solution
If needed, have someone else pour additional amounts of solution into the tray
Apply sterile barrier drapes

23. Procedure (continued)
Apply antiseptic solution
Wing sponges are used to perform the scrub
Wet the sponges with scrub solution
Start at the center of the intended incision site
Use a circular motion and work outward toward the periphery of the skin prep boundaries
Apply enough pressure and friction to remove dirt, debris, and microbes

24. Procedure (continued)
After reaching the skin prep boundary, discard the sponge
Repeat the scrub process for prescribed amount of time
Remember
Never bring a used sponge back to an area that has already been prepped
Remember to separate the clean from the dirty areas

25. Procedure (continued)
Blot the area with an absorbant towel
To remove the towel, grasp the opposite corners, lift and pull the towel towards self
Do not “drag” over prepped area
Repeat if necessary
Apply “paint” solution
Sponges on the stick are usually used for this step
Wet the sponges with the paint solution

26. Procedure (continued)
Apply the paint in the same circular fashion as the scrub
Begin at the intended incision site and work outward
Remove the barrier drapes that were placed to absorb the runoff solutions
Do not contaminate prepped area when removing drapes
May be necessary to move to opposite side or OR table to remove

27. Important Notes

28. Notes
Areas of the body suspected to have cancer cells, such as the breast, should not be scrubbed
Only a gentle paint is applied
Scrubbing can dislodge cancer cells which can then be picked up by the blood stream or lymph system for transportation to other parts of the body

29. Notes (continued) Scrub brushes with bristles should not be used
Bristles can dislodge and fall into surgical wound
Bristles are abrasive to the skin

30. Notes (continued) One-step prep kits are commercially available
Combination scrub and paint solution is stored in the handle
The end of the applicator is a foam sponge
Pressing on the sponge releases the solution
Same principle of using a circular motion applies

31. Contaminated Areas

32. Stoma
Stoma can be sealed off from surgical site using plastic towel drape
If use of towel drape not possible use one of the following options
Gently pack the opening of the stoma with an antiseptic soaked sponge while performing the skin prep
Cover stoma with an antiseptic soaked sponge; prep the stoma last
Each repeat of the scrub; use a separate sponge to gently scrub the stoma

33. Umbilicus Options Prep abdomen to include umbilicus
Clean umbilicus first
Use Q-tips® to avoid runoff of dirty solution over clean area
Umbilicus may be cleansed one last time at end of pres
If dirt and debris are hardened, soften by squeezing antiseptic solution into the umbilicus
Perform abdominal prep around the umbilicus
Thoroughly cleanse umbilicus as last step with separate Q-tips®

34. Preparation for Skin Graft

35. Skin Graft Two prep sets are required Donor site scrubbed first
One for the recipient site
One for the donor site
Donor site scrubbed first
Site scrubbed with a colorless antiseptic solution such as Hibiclens®
Surgeons view of graft not obscured

36. Skin Graft (continued)
Recipient Site
Sponges used to prep recipient site must not come into contact with the donor site
Excess solution (runoff) from the recipient site must not come into contact with the donor site