principles of patient skin preparation

8/13/2019 Principles of Patient Skin Preparation

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HAIR REMOVAL –carried out per surgeon’s order,whether on the preoperative unit or in the OR as close to thescheduled time for surgical procedure as possible.

CLIPPERS –electric clippers with fine teeth cut hair close tothe skin. Clipping can be done immediately before the

surgical procedure or up to 24 hours preoperatively. DEPILATORY CREAM –hair can be removed by chemical

depilation before the patient comes to the OR suite. Thisshould not be used around the eyes or genitalia. After thecream has remained on the skin for the required time,usually about 20 min, it is washed off. The hair comes off in

the cream. RAZOR –shaving should be performed as near the time of

incision as possible if this method is used. SKIN DEGREASING –it is used to enhance adhesion of

ECG or other electrodes.



The sterile items being prepared:

*small table drape *sterile gloves *2 absorbenttowels *2 or 3 small

*cotton-tipped applicator *gauze sponges



The surgical site is bordered by sterile towelsafter donning the sterile gloves. The soapyantiseptic sponges are used to mechanically an

chemically cleanse the skin in a circular motionfrom the incisional sit to the periphery. Thepaint-style antiseptic solution is applied in thesame manner, using a circular motion from he

incisional site to the periphery.



‘UMBILICUS : some surgeons prefer the umbilicus to becleaned with cotton-tipped swabs before the main incision.`STOMA :should be isolated with a sterile clear plasticadhesive dressing to prevent fecal material from enteringthe wound..

`OTHER CONTAMINATED AREAS: the general rules ofscrubbing the most contaminated area last with separatesponges applies.`FOREIGN SUBSTANCES –a none-irritating solventshould be used to cleanse the skin.`TRAUMATIC WOUNDS –the wound may be packed or

covered with the sterile gauze while the area around it isthoroughly scrubbed and shaved if necessary.`AREAS PREPARED FOR GRAFTS –the donor site for askin graft should be scrubbed with a colorless antisepticagent so that surgeon can properly evaluate the vascularityof the graft postoperatively.



QUALITIES OF AN IDEAL ANTISEPTIC SKINCLEANSING AGENT:

it has broad-spectrum antimicrobial action andrapidly decreases the microbial count.it can be quickly applied and remains effectiveagainst microorganisms.it can be safely used without skin irritation orsensitivization.

it effectively remains active in the presence ofalcohol, organic matter, soap, or detergent.it should be non-flammable for use with laser,electrosurgical, or other high-energy devices.



CHLORHEXIDINE CLUCONATE –used asantiseptic skin cleansing soap preoperatively.IODINE AND IODOPHORS –it is used forwound care

ALCOHOL –a 70% concentration with continuouscontact for several minutes is satisfactory for skinantisepsis if the surgeon prefers a colorlesssolution that permits observation of true skin

color. TRICLOSAN –is a broad spectrumantimicrobial agent.PARACHLOROMETAXYLENOL –has abactericidal properties useful for skin antisespsis.



HEAD AND NECKEYE :1. The eyebrows are never shaved or removedunless the surgeon deems this essential.2. The eyelashes may be trimmed, if ordered bythe surgeon, with fine iris scissors coated withsterile water-soluble lubricant to catch thelashes.

3. The eyelids and preorbital areas are cleansedwith nonirritating antiseptic agent.4. The conjunctival sac is flushed with anontoxic agent



EARS, FACE OR NOSE :1. Skin surfaces should be cleansed at least tothe hairline.

2. Cotton applicators are used for cleansing thenostrils and external ear canals.3. Protect the eyes with a piece of sterile plasticsheeting.



LATERAL THORACOABDOMINAL AREA1. The gown is removed.2. The arm is held up during the prep. 3. Beginning at the site of injection, the area may include theaxilla, chest, and abdomen from the neck to the iliac crest

CHEST AND BREAST1. The anesthesia provider turns the patient’s face forwardthe unaffected side.2. Our towel is folded under the blanket edge, just above thepubis. 3. Thearm on the affected side is held up by grasping the hand

raising the shoulder and axilla slightly from the operatingbed.4. The area includes the shoulder, upper arm down to theelbow, axilla, and chest wall to the table line and beyond thesternum to the opposite shoulder.



1. A moisture-proof pad should be placed onthe operating bed under an extremity.2. A full extremity prep may e done in 2 stages.

3. Caution must be taken to prevent solutionfrom pooling under a tourniquet.



UPPER ARM1. A towel is placed under the shoulder and axilla.2. The arm is held up by grasping the hand andelevating the shoulder slightly from the OR bed.

3. The area includes the entire circumference of thearm to the wrist, the axilla and over the shoulderand scapula.ELBOW AND FOREARM

1. A towel is placed under the shoulder and axilla.2the arm is held up by grasping the hand.3. The area includes the entire arm from theshoulder and axilla to and including the hand.



THIGH1. One towel is placed under the thigh on the ORbed.2. The leg is held up by supporting the foot and

ankle.3. The area includes the entire circumference of thethigh and leg to the ankle, over the hip andbuttocks to the table line, the groin and pubis.KNEE AND LOWER LEG1. A towel is placed over the groin.2. The leg is held up by supporting it at the foot.3. The area includes the entire circumference of theleg and extends from the foot to the upper part ofthe thigh.



1. Blood- and fluid-resistant to keep drapes dry and preventmigration of microorganisms.2. Lint-free to reduce airborne contaminants and shedinginto the surgical site. 3.Antistatic eliminate risk of a spark from the static electricity.

4. Sufficiently porous to eliminate heat buildup so as tomaintain an isothermic environment appropriate for thepatient’s body temperature.5. Drapable to fit around contours of the patient, furniture,and equipment. 6.Dull, nonglaring to minimize color distortion from reflected

light. 7. Freeof toxic ingredients.8. Flame-resistant to self-extiguish rapidly on removal of anignition source.



SELF-ADHERING SHEETING (sterile,waterproof, antistatic, and transparent ortranslucent plastic sheeting may be applied to dryskin.)INCISE DRAPE –the entire clear plastic drape hasan adhesive that is applied to the skin.TOWEL DRAPE –the plastic sheeting has a bandof adhesive along the edge. It will remain fixed onthe skin without towel clips.APERTURE DRAPE –adhesives surrounds afenestration in the plastic sheeting. This secures thedrape to the skin around the surgical site, such asan eye or ear.



TOWELS –disposable or reusable sterile towelsmay be used to outline the surgical site afterprepping the skin. They are usually packaged

in group of four and can be secured withnonperforating towel clips.FENESTRATED SHEETS –the drape sheet hasan opening that is placed to expose the

anatomic area where the incision will be made.



1. Place drapes on a dry area.2. Allow sufficient time to permit carefulapplication.3. Allow sufficient space to observe sterile

technique.4. Handle drapes as little as possible.5. Never reach across the operating bed to drapethe opposite side; go around it.6. Take towels and towel clips, if used, to the sideof the operating bed from which the surgeon isgoing to apply them before handing them to himor her.



7. Carry folded drapes to the OR bed.8. In unfolding a sheet from the prepped areatoward the foot or head of the OR bed, protect thegloved hand by enclosing it in a turned-back cuffof sheet provided for this purpose.9. If a drape becomes contaminated, do not handleit further.10. A towel clip that has been fastened through adrape has its points contaminated.11. If a hole is found after it is laid down, the holemust be covered with another piece of drapingmaterial or the entire drape discarded.12. A hair found on a drape must be removed, andthe area must be covered immediately.

principles of patient skin preparation

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