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1. SKIN PREPARATION
OF THE
SURGICAL PATIENT

2. 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

3. COMPONENTS
• MECHANICAL CLEANSING
• HAIR REMOVAL
• SKIN PREP

4. MECHANICAL CLEANSING

5. 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

6. HAIR REMOVAL

7. 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

8. HAIR REMOVAL
• an order for hair removal should
be written in the Doctor's orders
• removal techniques include:
– shaving
– clippers
– depilatory cream

9. SKIN PREP

10. CONCEPTS
• mechanical cleansing
– pressure
– friction
• chemical antisepsis

11. SUPPLIES

12. SUPPLIES
• Basins for antiseptic soap and/or solution

13. SUPPLIES
• applicators
– Usually gauze sponges - not radio-opaque!!!
– Cotton tip applicators for hard-to-reach areas

14. SUPPLIES
• towels for drying
• sterile gloves

15. SUPPLIES
• pads to collect excess prep solution to
prevent pooling of the solutions under the
patient during surgery

16. COMMON PREPPING
SOLUTIONS

17. COMMON PREPPING
SOLUTIONS
• Chlorhexidine gluconate

18. 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

19. COMMON PREPPING
SOLUTIONS
• Alcohol
– Isopropyl 70%

20. COMMON PREPPING
SOLUTIONS
• Hexachlorophene
Phisohex
Phisoderm

21. PROCEDURE

22. PROCEDURE
• Assemble necessary equipment
• establish a sterile field
• 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

23. 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
• Don sterile gloves
– open gloving without a gown technique
• Wet the applicator with scrub solution

24. PROCEDURE
areas included in the prep for each operative procedure

25. PROCEDURE
• scrub the skin in a circular motion
• start at the incision point and work
toward the periphery

26. PROCEDURE
• Discard the sponge after reaching the
periphery and obtain a new one to continue
• Scrub for a minimum of five minutes or
according to hospital policy
• 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

27. PROCEDURE
• Apply paint solution using gauze on sponge
sticks
– working from the incision line to the periphery

28. SPECIALIZED PREP AREAS

29. SPECIALIZED PREP AREAS
• The umbilicus is considered contaminated
– this should be thoroughly cleaned
using separate gauzes, prior to
starting the skin scrub

30. SPECIALIZED PREP AREAS
• 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

31. SPECIALIZED PREP AREAS
• Areas of high microbial counts are
considered contaminated and are
prepped last with each sponge
– axilla
– groin
– hair line

32. 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

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

34. 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

35. 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

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