SKIN PREPARATION

OF THE
SURGICAL PATIENT
 PURPOSE

– to render the operative site as

free as possible from transient
and resident microorganisms,
dirt, and skin oil so the incision
can be made through the skin
with a minimal danger of
infection from this source
 COMPONENTS

• MECHANICAL CLEANSING
• HAIR REMOVAL
• SKIN PREP
MECHANICAL CLEANSING
 MECHANICAL CLEANSING

• bathing the evening/morning before

surgery with an antimicrobial soap
• hair should be washed, especially for
cases of the head and neck
– NOTE: abnormal skin irritation, infection,
or abrasion on or near the operative site
may be a contraindication to the
performance of the surgical procedure
HAIR REMOVAL
 HAIR REMOVAL

• breaks in the skin permit the entry

and colonization of microorganisms,
a potential source of infection
• hair removal should take place as
close to the time of surgery as
possible, but not in the OR suite
so as to minimize environmental
contamination of the room
 HAIR REMOVAL

• an order for hair removal should

be written in the Doctor's orders
• removal techniques include:
– shaving
– clippers
– depilatory cream
SKIN PREP
 CONCEPTS

• mechanical cleansing
– pressure
– friction
• chemical antisepsis
SUPPLIES
 SUPPLIES

• basins for antiseptic soap and/or solution

 SUPPLIES

• applicators
– usually gauze sponges - not radio-opaque!!!
– q-tip applicators for hard-to-reach areas
 SUPPLIES

• towels for drying

• sterile gloves
 SUPPLIES

• pads to collect excess

prep solution to
prevent pooling of the
solutions under the
patient during surgery
COMMON PREPPING
SOLUTIONS
 COMMON PREPPING
SOLUTIONS

• Chlorhexidine gluconate
– Hibiclense
– Hibitane tincture
 COMMON PREPPING
SOLUTIONS
• Iodine and iodophors
– povidone iodine -
Betadine
– do not use on patients
with sensitivity to
shellfish!
– may cause
irritation/burn to skin if
warmed
 COMMON PREPPING
SOLUTIONS

• Alcohol
– Isopropyl 70%
– is flammable - do
NOT allow to pool,
especially with ESU
and LASER cases
 COMMON PREPPING
SOLUTIONS

• Hexachlorophine
– Phisohex
– Phisoderm
PROCEDURE
 PROCEDURE

• Assemble
necessary
equipment
• establish a sterile
field
 PROCEDURE

• Pour solutions
– if not premixed, scrub solutions need to
be diluted with sterile water
– this may be done with sterile gloves
donned if the containers are sterile also
 PROCEDURE
• Expose the site to be prepped,
making sure that the blanket will not
become contaminated with
prepping solution
• Place protective pads
around the patient
to collect excess
prepping solution
 PROCEDURE

• Don sterile gloves

– open gloving without a gown technique
• Wet the applicator with scrub solution
 PROCEDURE

areas included in the prep for each operative procedure

 PROCEDURE

• scrub the skin in a

circular motion
• start at the incision
point and work
toward the
periphery
 PROCEDURE

• Discard the sponge after reaching the

periphery and obtain a new one to continue
 PROCEDURE

• Scrub for a minimum of five minutes

or according to hospital policy
 PROCEDURE

• Dry the area with a sterile towel by

placing the towel and then patting
the area, using the cuff to lift the
towel off the skin when completed
 PROCEDURE

• Apply paint solution using gauze on sponge

sticks
– working from the incision line to the periphery
SPECIALIZED PREP AREAS
 SPECIALIZED PREP AREAS
• The umbilicus is considered contaminated
– this should be thoroughly cleaned
using separate gauzes, prior to
starting the skin scrub
• Stomas, skin ulcers, sinuses and open
wounds are considered contaminated
– a one inch area around the opening
is left during the prep and that area
is cleansed with the last strokes of
each sponge
SPECIALIZED PREP AREAS

• Areas of high microbial counts are

considered contaminated and are
prepped last with each sponge
– axilla
– groin
– hair line
SPECIALIZED PREP AREAS

• When prepping perineum

– the mons pubis is cleansed first
– then the labia majora
– the thighs outward
– the labia minora and vestibule
– the vagina
– the rectum
 SPECIALIZED PREP AREAS

• Skin grafts
– separate preps must be used for
the donor and recipient sites
– the donor site is prepared first
SPECIALIZED PREP AREAS

• Eyes
– eyebrows are NEVER shaved!
– eyelashes may be trimmed with iris
scissors covered with vaseline jelly to
catch the lashes as they are trimmed
SPECIALIZED PREP AREAS

• Eyes
– the orbit is prepped with a drop of
iodine solution/saline and irrigated
with sterile saline from the nose side
to the lateral side
– lids are prepped with q-tips dipped in
solution and blotted on sterile gauze
 DOCUMENTATION

• should include:
– skin condition
– hair removal technique
– prep solutions
– person performing the prep