Prepping

1. Prepping The surgical skin prep is performed on the surgical patient for the same reasons that the sterile surgical team members perform the surgical scrub prior to entry into the sterile field.

2. WHY?? • To remove transient organisms from the patient’s skin • To reduce the number of resident organisms on the patient’s skin

3. To shave or NOT to shave? • Hair removal, does it interfere with the electrode placement, the surgical site, wound closure and dressing application • It may be removed according to surgeon’s preference, facility policy, age and gender of the patient, and the planned operative site

4. Hair removal continued….. • Shave as close as possible to the planned procedure to reduce the risk of microbial growth in any breaks in the skin • Be sure that the privacy of the awake patient is ensured to avoid embarrassment during the process

5. Other Factors related to the Skin Prep • All necessary procedures must be carried out prior to performing the surgical skin prep • Anesthesia administration • Foley Catheterization • Positioning • Exposure of surgical site • Hair removal • Skin Marking

6. Gross soil & skin oils must be removed from the planned operative site: • May require use of a fat solvent or degreaser • May require us of a scrub brush and/or nail cleaner

7. Prep Fluids • May NOT be allowed to accumulate adjacent to or under the patient • May cause a chemical irritation • Increased the risk of ESU or Laser burn • Consider the patient’s allergy status prior to application

8. Certain Contaminated areas: • May require special attention • General rule: prepping the surrounding areas first and the contaminated areas last and to use a separate sponge for each area. • Exceptions: • Mucous membranes • Stomas • Nonintact skin • Sinus tracts • Umbilicus

9. Some more prepping considerations.. • Two separate skin preps may be necessary in certain situations • Prep is initiated at eh planned incision site and carried toward the periphery (circular motion) • An assistant may be necessary to hold a limb that must be circumferentially prepped • Recommendations of the antiseptic manufacturer must be followed • Preoperative skin markings are not removed during the surgical skin prep

10. NOTE******** • Some of the preparatory steps may also apply to the skin sites selected for placement of the dispersive electrodes for the ESU and the ECG electrodes

11. Types of Skin Solutions used in the OR • Alcohol: Rapid and significant reduction in skin microbial counts • Iodophors: Less likely to cause skin irritation and do not need to be removed • Chlorhexidine: Does not provide as rapid a reduction in skin microbial couns as alcohol, but provides longer residual effects (5-6 hours)

12. Several Products Available: • Scrub soaps • Scrub solutions • Single-use prep applicators (emergency C-Section) These agents used should be a broadspectrum antimicrobial and should provide residual protection. The agent chosen for use should be based on the particular patient and skin sensitivity

13. NOTE………….. • The items necessary for final skin preparation should be arranged on a separate sterile Mayo stand or prep stand. Prep packs are available in sterile form, containing all the necessary equipment except for the antiseptic scrub solution and “Paint” soulution.

14. Single Use Applicators • Alcohol based antiseptic solution that leaves an antimicrobial film. • Self contained units (need to be activated) • Shown to have long lasting antimicrobial effect • Leave an antimicrobial film on the skin

15. PREPS!! • Abdominal and Thorcoabdominal • Chest and Breast • Eyes, Ears, Face and Nose • Extremities • Perineal and Vaginal Preps • Please see pages 356-357 Skin prep perimeters

16. Preps to be practiced in the LAB • Laparotomy - Supine • Knee arthroscopy – Supine (extremity) • Nephrectomy – Kidney (right or left) depends on which side patient is laying… • Vaginal hysterectomy - Lithotomy