The LSUHSC New Orleans Emergency Medicine Interest Group Presents The Student Procedure Manual

Preoperative Skin Preparation of Patients

Purposes and Principles

• These recommended practices provide a guideline for the preoperative skin preparation of the operative site. The goal of the preoperative skin preparation is to reduce the risk of postoperative wound infection by:
  • removing soil and transient microbes from the skin
  • reducing the resident microbial count to subpathogenic amounts in a short period of time and with the least amount of tissue irritation, and inhibiting rapid rebound growth of microbes.
• The area surrounding the operative site should be clean.
  • Cleansing can be accomplished before surgery by:
    • Patient shower(s)
    • Washing the operative site on the patient unit, and/or
      
    • Washing the operative site immediately before applying the antimicrobial agent in the OR.
  • The operative site should be assessed before skin cleansing. Skin integrity and allergies affect the choice of a cleansing agent. Traumatized, denuded, and/or burned skin may require saline irrigation as the cleansing agent.
    • Hair should remain at the operative site unless it is so thick that it interferes with the surgical procedure (eg, craniotomy).
    • If hair removal is requested, it should be performed in a patient care area that affords privacy and good lighting, and it should be done by a person who has demonstrated skill in the procedure.
    • Three possible methods for the removal of hair from the skin around the operative site are as follows:
      • a depilatory.
      • an electric clipper with a disposable or removable head that can be sterilized between patients, and
      • a sharp, well-designed disposable or terminally sterilized razor.
    • Shaving should be done as close to the time of the operative procedure as possible.
    • The wet method of shaving is desirable.
    • Persons performing the shave prep should wear protective gloves.
    • If shaving is performed more than a few hours before surgery, even microscopic abrasions provide a good culture medium for microorganism with subsequent risk of wound infection.
• The skin of the operative site and surrounding area should be prepared with an antimicrobial agent(s) before the incision.
  
  • Patient sensitivity, anatomy, and the condition of the skin at the operative site influence the choice of agent(s).
    
  • The area of prep should be wiped, and sterile equipment should be used. A person who has demonstrated skill in the procedure should use a prescribed
    technique taking into consideration the following:
    
    • condition of the skin at the incision site.
      
    • presence of areas of high bioburden within the
      prepped area.
      
    • presence of mucous membrane, bowel, and/or denuded tissue.
      
    • anatomy involved.
      
    • proposed surgical procedure, and
      
    • size of drape fenestration.
      
  • The agent(s) should be applied in a manner that prohibits pooling beneath the patient, tourniquet, electrodes, or electrosurgical dispersive pad.
    
  • If electrosurgery is to be used, sufficient time should elapse between the skin preparation and application of drapes to permit complete evaporation of any flammable substance, such as alcohol or fat solvents.