SURGICAL
SKIN PREP
AND
DRAPING
SURGICAL ASEPSIS
• Asepsis refers to the absence of infectious material or infection.
• Surgical asepsis is the absence of all microorganisms within any type of
invasive procedure.
• Sterile technique is a set of specific practices and procedures performed to
make equipment and areas free from all microorganisms and to maintain that
sterility.
SAFETY CONSIDERATIONS
• Hand hygiene is a priority before any aseptic procedure.
• When performing a procedure, ensure the patient understands how to prevent
contamination of equipment and knows to refrain from sudden movements or
touching, laughing, sneezing, or talking over the sterile field.
• Choose appropriate PPE to decrease the transmission of microorganisms from
patients to health care worker.
• Review hospital procedures and requirements for sterile technique prior to initiating
any invasive procedure.
• Health care providers who are ill should avoid invasive procedures or, if they can’t
avoid them, should double mask.
PRINCIPLES OF STERILE TECHNIQUE
• Principles of sterile technique help control and prevent infection, prevent the
transmission of all microorganisms in a given area, and include all techniques that
are practiced to maintain sterility.
• Sterile technique is most commonly practiced in operating rooms, labor and
delivery rooms, and special procedures or diagnostic areas. It is also used when
performing a sterile procedure at the bedside, such as inserting devices into sterile
areas of the body or cavities (e.G., Insertion of chest tube, central venous line, or
indwelling urinary catheter).
• In health care, sterile technique is always used when the integrity of the skin is
accessed, impaired, or broken (e.G., Burns or surgical incisions). Sterile technique
may include the use of sterile equipment, sterile gowns, and gloves
• Sterile technique is essential to help prevent surgical site infections (SSI), an
unintended and oftentimes preventable complication arising from surgery. SSI
is defined as an “infection that occurs after surgery in the area of surgery”
Preventing and reducing SSI are the most important reasons for using sterile
technique during invasive procedures and surgeries.
PRINCIPLES OF STERILE TECHNIQUE
1. All articles used in an operation have been sterilized previously.
2. Persons who are sterile touch only sterile articles; persons who are not sterile
touch only unsterile articles.
3. Sterile persons avoid leaning over an unsterile area; non-sterile persons avoid
reaching over a sterile field. Unsterile persons do not get closer than 12 inches
from a sterile field.
4. If in doubt about the sterility of anything consider it not sterile. If a non-sterile
person brushes close consider yourself contaminated.
5. Gowns are considered sterile only from the waist to shoulder level in front and the sleeves to
2 inches above the elbows.
1. Keep hands in sight or above waist level away from the face.
2. Arms should never be folded.
3. Articles dropped below waist level are discarded.
6. Sterile persons keep well within the sterile area and follow those rules from passing:
4. Face to face or back to back.
5. Turn back to a non-sterile person or when passing.
6. Face a sterile area when passing the area.
7. Ask a non-sterile person to step aside rather than trying to crowd past him.
8. Step back away from the sterile field to sneeze or cough.
9. Turn head away from sterile field to have perspiration mopped from brow.
[Link] back at a safe distance from the operating table when draping the patient.
[Link] of the sterile team remain in the operating room if waiting for the case.
[Link] not wander around the room or go out in the corridors.
7. Sterile persons keep contact with sterile areas to a minimum.
1. Do not lean on the sterile tables or on the draped patient.
2. Do not lean on the nurse’s mayo tray.
8. Non-sterile persons — when you are observing a case, please stay
in the room until the case is completed. Do not wander from room to
room as traffic in the operating room should be kept as a minimum.
Patient privacy needs to be respected.
9. Keep non-essential conversation to a minimum.
SCRUBBING
• Allow the water to run (figure1) and cover the nail pick and brush with soap, using your
elbows on the soap dispenser; clean your nails and remove any gross debris from your hands
(figure 2)
• Start by scrubbing your hands and forearms, down to your elbows, using the WHO hand
washing procedure for the hands and a rotational action for your forearms (figure3); this
should last for at least one minute.
• Wash the soap from your hands and forearms by holding up your arms with your
hands elevated under the tap, such that the water runs off into the sink from your elbows (figure 4)
• Repeat this procedure a further three times, initially down to the mid-forearm (figure 2.5), then down
to the wrists (figure 6), then just for the hands (figure 7), each time lasting for at least one minute.
• Keeping your arms elevated (figure 8), dry your hands and forearms with the sterile towels in the
gowning pack, using a dabbing motion instead of a wiping motion (figure 9); use one towel for each
hand, before throwing them away.
GOWNING AND GLOVING
• Take the sterile gown (figure 1) and gently shake it out, taking care not to let anything else touch it
(figure 2)
• Open it up and place your hands into the sleeves (figure 3,4); keep your hands inside the sleeves
(figure 5)
• Ask an assistant to help pull it up over your shoulders and fasten it up at the back
• Take the right hand glove and place it, palm down, fingers facing your body (figure 3.6)
• Grasp the bottom of the cuff with the thumb and index finger of your right hand, still inside
the sleeve (figure 3.7); grasp the top of the cuff with your left hand (also inside the sleeve)
and pull the glove around and over your right hand (figure 3.8)
• Pull gently on the sleeve of the gown to help move your hands into the gloves and straighten
out the fingers (figure 3.9); the sleeves of the gown should remain over most of your palm
• Repeat this technique for the left hand
TO GOWN AND GLOVE THE SURGEON
• Pick up a gown from the sterile linen pack. Step back from the sterile field and let the gown
unfold in front of you. Hold the gown at the shoulder seams with the gown sleeves facing you.
• Offer the gown to the surgeon. Once the surgeon’s arms are in the sleeves, let go of the gown.
Be careful not to touch anything but the sterile gown. The circulator will tie the gown.
• Pick up the right glove. With the thumb of the glove facing the surgeon, place your fingers and
thumbs of both hands in the cuff of the glove and stretch it outward, making a circle of the
cuff. Offer the glove to the surgeon. Be careful that the surgeon’s bare hand does not touch
your gloved hands.
• Repeat the preceding step for the left glove.
SURGICAL SKIN PREPARATION
SKIN DISINFECTION
• Why use antiseptics to disinfect the skin prior to surgery?
• Cleaning the skin with soap and water removes dirt, skin secretions such as sweat and
sebum, together with superficial microorganisms. However, microorganisms that live
in the folds of the skin, sebaceous glands and hair follicles are not removed by
washing. The aim of skin disinfection is to apply antiseptic solutions to rapidly kill or
remove skin microorganisms at the site of the incision and reduce the risk of
contamination of the surgical site.
• When should skin antiseptics be applied?
• Preparation of the surgical site should occur as close to the point of surgery as
possible and immediately prior to draping. There is no evidence to suggest that
multiple applications of different skin antiseptics increases efficacy
• What antiseptics can be used for skin preparation?
• The two main antiseptic agents used for pre-operative skin preparation are:
• chlorhexidine gluconate (CHG)
• Iodophors (povidone iodine; PI)
• How should skin antiseptics be applied?
• The incision site should be rubbed with sufficient solution to adequately cover the site
and ensure that microorganisms in skin folds and sebaceous glands are treated.
• Either gauze swabs or commercially available applicators are effective in achieving this.
• The solution must be allowed to dry on the skin before drapes are fixed and the incision is
made, in order to enable sufficient time for the antiseptic to kill the microorganisms on
the skin
• Pectoral region
LOCATION OF PRE- • Subclavian vien or cephalic vien
PECTORAL • 4cm to 6m incision is made in subclavian region, below and parallel
POCKET to the clavicle
DRAPING
• The procedure of covering a patient and surrounding areas with a sterile barrier to create
and maintain a sterile field during a surgical procedure
• The purpose of draping is to eliminate the passage of microorganisms between
nonsterile and sterile areas.
• Draping materials may be disposable or non disposable. Disposable drapes are generally
paper or plastic or a combination and may or may not be absorbent. Non disposable
drapes are usually double-thickness muslin. Drapes, of course, must be sterile.
PRINCIPLES OF DRAPING
• Sterile towels are used to outline the prepared surgical site.
• The folded laparotomy sheet is then placed on the prepped patient.
• The fenestration (opening) of the sheet should be directly on top of the
surgical site. The fenestration is reinforced for additional protection and
control of seepage of blood, body fluids, and other potentially infectious
materials.
• The sterile gloves of the scrub person are protected by keeping them under
the cuff of the folded laparotomy sheet.
• The drape is unfolded over the sides of the patient and the procedure or
operating table or bed.
• The upper part of the sheet is unfolded toward the head of the bed and
draped over the anesthesia screen.
• The bottom of the sheet is draped over the foot of the bed.
ASEPTIC NON-TOUCH TECHNIQUE (ANTT)
ANTT refers to the infection control methods and precautions necessary during invasive
clinical procedures to prevent the transfer of microorganisms from health professionals,
procedure equipment or the immediate environment, to the patient.
Principles of ANTT procedure are:
• Always decontaminate hands
• Never contaminate key parts of sterile materials/equipment or key site
• Touch non-key parts with confidence
• Take appropriate infective precautions e.G. PPE, waste disposal.
IDENTIFY AND PROTECT
KEY PARTS AND SITES
.
A ‘key part’ is the part of the equipment that must remain sterile,
such as a syringe hub, and must only contact other key parts or
key sites.
A ‘key site’ is the area on the patient such as a wound, or IV
insertion site that must be protected from microorganisms.
• Ensure aseptic key parts only contact other aseptic key
parts/sites.
THE KEY RESPONSIBILITY FOR THE
PERIOPERATIVE NURSE IS TO MAINTAIN A
STERILE ENVIRONMENT FOR THE PATIENT
AND SURGICAL TEAM BEFORE, DURING, AND
AFTER SURGERY.
1. ALL OBJECTS USED IN A STERILE FIELD
MUST BE STERILE.
• Commercially packaged sterile supplies are marked as sterile; other packaging
will be identified as sterile according to agency policy.
• Check packages for sterility by assessing intactness, dryness, and expiry date
prior to use.
• Any torn, previously opened, or wet packaging, or packaging that has been
dropped on the floor, is considered non-sterile and may not be used in the sterile
field.
2. A STERILE OBJECT BECOMES NON-
STERILE WHEN TOUCHED BY A NON-
STERILE OBJECT.
• Sterile objects must only be touched by sterile equipment or sterile gloves.
• Whenever the sterility of an object is questionable, consider it non-sterile.
• Fluid flows in the direction of gravity. Keep the tips of forceps down during a
sterile procedure to prevent fluid travelling over entire forceps and potentially
contaminating the sterile field.
3. STERILE ITEMS THAT ARE BELOW THE
WAIST LEVEL, OR ITEMS HELD BELOW
WAIST LEVEL, ARE CONSIDERED TO BE
NON-STERILE.
• Keep all sterile equipment and sterile gloves above waist level.
• Table drapes are only sterile at waist level.
4. STERILE FIELDS MUST ALWAYS BE KEPT
IN SIGHT TO BE CONSIDERED STERILE.
• Sterile fields must always be kept in sight throughout entire sterile
procedure.
• Never turn your back on the sterile field as sterility cannot be
guaranteed.
