Preoperative skin preparation

1. Preoperative skin preparation Dr. Aidah Abu Elsoud Alkaissi An Najah National University Faculty of Nursing Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

2. Preoperative Skin PreparationNursing Consideration • The preoperative skin preparation of a surgical patient is the first step in the prevention of wound infection • The nurse should explain the purpose and method of the procedure • Every effort should be made to allay any fears the patient may express and to answer questions in a reassuring manner • During the procedure the nurse should observe the patient´s general condition, particularly the condition of the skin under treatment • Any contraindication to the procedure should be documented • Provide the comfort, safety and privacy of the patient • Good alignment of the patiemt´s body should be maintained and special supports for positioning shoild be used as indicated Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

3. Initial preparation of operative area • In the immediate preoperative period, the skin of the involved part of the body is prepared by special cleansing • Hair should be removed from the operative site only as necessary • Three alternatives for hair removal are clipping, use of depilatory and wet shaving • Studies show that the wound infection rate is considerably higher for patients who are shaved preoperatively than for patients who have no preoperative shave preparation or a small amount of hair clipped or for patients on whom a depilatory is used • If a shave is ordered by the surgeon, the patient should be shaved immediately before surgery, preferably in a holding area within the surgical suite that afford privacy and is equipped with good lighting facilities Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

4. Initial preparation of operative area • The amount of time between the preoperative shave and the operation has a direct effect on the wound infection rate • In shaving the site, great care should be taken to avoid scratching, nicking or cutting the skin because cutaneous bacteria will proliferate in these areas and increase the chances of infection • Specific orders for the skin preparation are written by the surgeon • A manual with diagrams and instructions concerning the preoperative skin shave is useful for the guidance and information of the personnel to whom the task is delegated • The extent of area to be shaved is determined by the site of the incision and the nature of the operation Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

5. Initial preparation of operative area • Shaving the face and neck of children or female patients is rarely necessary • The eyebrows are not shaved unless specifically ordered by the physician • The head and neck are not generally prone to wound infection because of the generous blood supply to this area • For cosmetic and psychological reasons, preparation for head and neck surgery may be done in the operating room after the induction of anaesthesia Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

6. Initial preparation of operative area • For the orthopedic surgery on the extrimities, the shave preparation usually extends from one joint above to one joint below the area of incision • If a pneumatic tourniquetwill be used during surgery, the entire extremity may be prepared to facilitate proper draping technique • Preparation and draping of the entire extrimity also permit manipulation of the limb during surgery • Greate care should be exercised in the preparation for surgery on bones because wound infection resulting from improper cleansing may cause a stubborn condition leading to crippling, disfigurement and permanent dysfunction • The skin may be difficult to clean if it has been affected by casts, splints or brces that interfere with normal skin care or cause skin damage Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

7. Initial preparation of operative area • Daily soaking may help to clean badly soiled feet in preparation for surgery justas daily washing is advisable in preparation for general elective surgery • Patients with traumatic injuries that may be excessively painful such as fracture, burns and soft tissue lacerations may require anesthesia for skin preparation • Traumatic wound usually require copious irrigationto flush out foreign matter • In cleansing the injured area, the surriounding skin is first carefully washed with an antimicrobial detergent • The open wound is irrigated with an isotonic solution and the area is treated with an antimicrobial solution Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

8. Initial preparation of operative area • If a patient must e shaved in the operating room, a clippings and epithelium removed by the razor • Skin preparation in the operating room has the disadvantages that the patient´s anesthesia time is prolonged , optimum useof the operating room is infringed on, loose hair remaining on the surrounding linen may get into the wound and water used to wash the skin can result in sterile drapes becoming wet Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

9. Procedure for preoperative shave • Individual supplies are used for each patient • Disposable preparation trays and razors can help ensure a safe personal technique • The use of disposable gloves is a safeguard for the pat and for the worker • Blankett and support for the patient´s position, necessary lighting and handwashing facilities Basic essential for shaving the site of incision are vailable • Basic equipment includes gloves, basins for warm water and soap , a disposable razor, sponges for washing, and towels or water proof for daping Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

10. Procedure for preoperative shave • Solvent solution may required to remove adhesives ir nail polsh • Volatile liquais such as alcohol and aceton should be strictly regulated because of the danger of fire or burns • Antimicrobial soap or detergent should be applied to the skin areas using sponges moistened with water • A lather is created by using circular motion and light friction • Beggining with the proposal site of incision and working towardthe periphery of the area • The principle is progression from cleansed areato unclensed one • Sponges are discarded as they become soiled and the process is contined with fresh sponges • Application of lather to skin hair for several minuetes before shaving enables the keratin of the hair to absoeb three to four times its weight in water • The water absorbtion makes the hair softer and easier to shave Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

11. Procedure for preoperative shave • A disposable razor with a sharp blade is used to shave off lathered hair • Holding the soft areas and loose skin taut (pulled or drawn tight) with the free hand rises the hair and permits easier access to the area • A clean shaved can be obtained without injury to the skin by gently stroking in the direction of hair growth • Nicks and cuts resulting from the shave should be reported as incidents, and the surgeon should be notified • The surgeon may be ordered a 5-minutes scrub of the prepared area with an antimicrobial soapor detergent after it has been shaved • If so the shaved area is scrubed and rinsed carefully and the skin is blotted dry to prevent chapping (To cause (the skin) to roughen, redden, or crack) and irritation Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

12. Final skin disinfection of operative area • After the patient has been positioned on the operating room bed, final skin cleansing and disinfection are performed • If the patient has not shower with an antimicrobial detergent or soap immediately before leaving for the operating room • The operative area may be prepared with an antimicrobial scrub solution • While this is being carried out, the shave can be inspected and touched up or extended as needed • Skin cleansing is followed by preparing with an antimicrobial solution Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

13. Prodeure for final skin preparing • Supplies arrange on a separate sterile prepping (Informal Preparation) table • The items should include stainless steel cups for the cleansing agent and the selected antimicrrobial agent, sterile sponges and sponge holding forceps • Cotton tipped applicator are needed to clean the umbilicus thouroughly and a scrub brush may be required fornaiös • Final skin disinfection may be done by the circulatin nurse or the surgeon • The skin scrub begins at the line of the proposed incision and proceeds to the periphery of the area • The antimicrobial agent is applied by sponges held in sponge holding forceps or in the gloved hand Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

14. Prodeure for final skin preparing • The gloved hand method requires that the glove be sterile at the beggining of the skin scrub and that the surface of the patients skin not be permitted to come into contact with the gloved hand • The sponges used in scrubbing are duscarded as they become soiled and fresh one are taken • A soiled sponge is never brought back over a scrubbed surface • The lather is wiped off with dry, sterile sponges • Depending upon the surgeon´s preference, an antimicrobial tincture, or paint may be carefully applied, avoiding any pooling beneath pat • All wet draped should be removed from the patient area after the skin scrub is complete Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

15. Prodeure for final skin preparing • Sponges used to cleanse or disinfect a wound, sinus, ulcer, intestinal stoma, the vagina, or the anus are applied once to that area immediately discarded • After prepping of the area, intestinal fistulas are generally walled off, using one of the plastic transparent adhesive drapes • Open wounds and body orifices are potentially contaminated areas and as such are prepped after the peripheral intact skin is cleansed • The surgical principle is always to scrub the cleanest area first Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden

16. Surgical scrub General consideration Dr. Aidah Abu Elsoud Alkaissi Division of Intensive Care and Anaesthesiology University of Linköping Sweden