Surgical Technology Lecture Series 2000©

Power-Point®

Skin Preparation - Part I

Surgical Prep

Prior to Draping

Production Notes

Author - Kevin Frey CST, MA

Series Editor - Teri Junge, MEd, CSFA, CST, FAST

Table of Contents

• Purposes of the Skin Prep

• Prep Tray

• Antiseptic Solutions

• General Skin Prep Procedure

• Important Notes

• Contaminated Areas

• Preparation for Skin Graft

Purposes of the Skin Prep

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

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

Prep Tray

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)

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

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

Antiseptic Solutions

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

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

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

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

Alcohol

• Ethyl or isopropyl alcohol – 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

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

General Skin Prep Procedure

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

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

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

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

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

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

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

Important Notes

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

Notes (continued)

• Scrub brushes with bristles should not be used– Bristles can dislodge and fall into surgical

wound– Bristles are abrasive to the skin

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

Contaminated Areas

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

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®

Preparation for Skin Graft

Skin Graft

• Two prep sets are required– 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

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