SKIN PREPARATION Definition: Skin preparation is the removal of as many bacteria as possible from the patients skin through

shaving, mechanical washing and chemical disinfection

PURPOSE: To reduce the risk of postoperative surgical site infection by removing soil and transient microorganisms from the skin, reducing the resident microbial count to subpathogenic levels in a short period of time and with the least amount of tissue irritation, and inhibiting rapid rebound growth of microorganisms.

Special Considerations: 1. To determine the area to be shaved, know the operation to be done, the organ involved and its location and the proposed incision. 2. The surgical site should be assessed before skin preparation. 3. Practice modesty and provide privacy. 4. Ask the patients permission in cutting the eyelashes and hair. 5. Examine the area to be shaved for any signs of irritation or any abnormal conditions. Report this to your head nurse. 6. Do not cut the patients skin. 7. In abdominal operations, pay particular attention to the umbilicus. 8. Shave the operative site the day or the night before operation. 9. Discard soiled sponges in your kidney basin borrowed from the ward. 10. In shaving, follow the direction of the growth of hair while the free hand exerts an opposite force by pulling the skin to the opposite direction. This is done: a. to make the shaving less painful b. to shave off the hair thoroughly from the skin 11. If a wound is present on the area to be shaved, start from the clean area to the dirty area. Equipment: Shaving tray with the following: 1. Razor with blade 2. Container with dry cherries or sponges 3. Container with cherries in liquid soap 4. Pick-up forceps 5. (2) Kidney basins Procedure: 1. Assemble all the articles and bring to the patients room. 2. Explain the procedure to the patient. 3. Provide privacy. 4. Place a rubber protector under the patient. 5. Expose the area to be shaved 6-8inches from the probable line of incision. 6. Using the pick-up forceps, get sponges saturated with liquid soap and make a thick lather on the skin staring from the probable line of incision going to the periphery. 7. Shave the area. 8. Clean the area with wet sponges. 9. Saturate again the skin with liquid soap and continue on shaving until the area is completely devoid of hair. 10. Dry with sponges. Areas to be Prepared: 1. Eye Operation cut the eyelashes of the affected eye. This is done in operating room. Use small straight eye scissors (Stevens). Clean with alcohol.

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Nasal and Sinus Operation no shaving is done unless the patient has moustache, with hairy face or hairy nose.

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Ear Operation shave 2 inches around the ear. Neck Operation anteriorly shave from the chin down to the nipple line. Laterally shave from the patients hairline to the sides of the neck including the shoulders and axilla. Posteriorly, shave the hairline down to the level of the clavicle. Chest Operation shave from the base of the neck to the waistline including the axilla and inner aspect of the arm. Posteriorly, shave from the shoulder line down to the waist extending 2 beyond the spinal column. Abdominal and Pelvic Operations shave from the nipple line down to the symphysis pubis, vulva, perineum and the thighs 2 inches from the groin. Include the sides or flanks of the patient. Kidney Operation anteriorly shave from the nipple line down to the perineum from side to side posteriorly on the affected side, shave from the subscapular area down to the buttocks and 2 inches beyond the spinal column. Vaginal, Scrotal, and Rectal Operations shave the waistline to the perineum. Include the anterior and inner aspects of the thighs 6 inches from the groin. Posteriorly, shave the entire buttocks. Pay particular attention to the hair between the folds of the buttocks and anus. Lower Extremity if the operation is in the distal portion, clean from the 2 inches above the knee, all around the extremity to the toes. If the operation is at the knee or little bit above or below it, clean the entire extremity from the groin to the toes. Pay attention to digital spaces. Upper Extremity if operation is at the distal portion, clean from 2 inches above the elbow to the fingers all around. If the operation is at the elbow or a little above or below it, shave from the axilla to the fingers and all around the extremity.

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Specific Skin Preps: 1. Abdominal Prep a. Clean the umbilicus with an anti-microbial soaked Q-tip and discard. b. Using a sponge in each hand the scrub starts at the line of the proposed incision, and then proceeds in a circular motion outward to the periphery of the area. c. Continue the prep as described above. 2. Abdominal / Perineal Prep a. Obtain two prep sets: one for the abdominal prep and one for the Perineal prep. b. Begin with the Perineal (below) prep: Place towel under buttocks after the patient is positioned. c. Wipe a sponge stick saturated with anti-microbial agent starting at the pubis over the labia and meatus and into the vagina; use only betadine paint solution for internal prep of the vagina. d. Using a circular motion with one sponge in each hand, prep medial and posterior thighs bilaterally. e. New sponge-start at the pubis and scrub over the labia majora, perineum and rectum. f. Repeat steps b and c again.

g. Dry the perineal area. h. Paint the same area in the same manner as the scrub; swab the vagina vault with a dry sponge stick. i. Drain bladder if requested. j. Open second prep: abdominal (above) prep. Put on new gloves using aseptic technique, and perform the abdominal prep d. Gather prep kit and supplies necessary to complete prep. i. Open kit and put on sterile gloves using aseptic technique. ii. Open scrub/paint and pour into container. iii. Place towels along edges to be prepped. iv. Squeeze out excess scrub and paint to avoid dripping and pooling underneath the patient resulting in potential irritation. v. Towels should always be placed to catch pooling; towels will be removed at completion of prep. vi. One or two hands may be used in applying prep solutions. vii. Use a circular motion when scrubbing the skin. Move from the incision site to the periphery of the area. viii. Discard sponges after scrubbing to the periphery, maintaining asepsis of the prep set. The soiled sponge is never brought back over the scrubbed surface. Use a new sponge when returning to the incision site.

k. Remove area towels and discard prep sets. 3. Orthopedic / Extremity Prep a. Position the affected extremity using appropriate positioning technique. b. Use appropriate sterile draping to catch any prep solution that may drip off of the prep site. c. It a positioning device is being used: i. Scrub the operative area where positioning device contacts patient skin. ii. Place an impervious towel under extremity before laying the extremity down on to positioning device. d. Use a brush as necessary for the nails and calloused skin on hands of feet. e. Using two sponges, the scrub begins at the site of the proposed incision i. Prep circumferentially around the extremity, Prep incision and move proximally to the incision. Discard the sponges.

f. Using the second two sponges, start at the site of the incision and prep distally in the same manner. g. Blot the extremity (unless specifically requested not to do so by the surgeon) by placing a towel over the extremity without contaminating the towel or the extremity. Make sure the edges of the towel do not drag over the prepped or non-prepped area as it is removed. h. Apply the paint in the same manner. i. Remove area towels and discard prep set.