THE UNlVlmSm

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OF TOLEDO
MEDICAL CENTER
Nursing Service
Standard of Care and Practice
03
Title:
Responsibility:
Standard of Care::
Purpose:
SURGICAL SKIN PREPARATION
RN
1. The agent used, to prepare the skin, will be noted on the physician's
preference list, unless patient allergies and sensitivities contraindicate use.
2. The preoperative skin prep will be charted on the OR record with the following
information:
condition of the skin prior to the prep
shave prep performed; clipping performed
skin prep solution used
person performing the prep
area prepped
To remove as much bacteria, dirt and skin oil as possible from the operative site and
surrounding area to reduce the chance of wound infection.
1. Skin can never be sterilized: surgical skin preps are clean procedures
following the best possible aseptic technique. The supplies are sterile even though
skin cannot be sterilized.
2. The prep begins at the line of the proposed incision and proceeds outward. The area
should be squared off with sterile towels to absorb any excess solutions when
applicable.
3. Whenever completing a skin prep on a contaminated or open draining wound, clean
the open site last to prevent the spread of contamination outward.
4. The area to be prepped should be assessed for the following:
condition of the skin
the presence of denuded tissue
anatomy
allergies
proposed procedure
area to be drapped
5. Keep the prep solution from pooling beneath the patient and away from the
electrosurgical patient electrode and tourniquets. Chemical burns may result if
allowed to remain in contact with the skin. Towels are used to soak up excess
solution after the prep is finished. All surgical prep solutions present a potential fire
hazard with special attention to the use ofChloroprep/Duraprep. Manufacturer's
guidelines state that a 3 minute dry time occur prior to applying surgical drapes.
6. All prep solutions will be used according to manufacturer's recommendations.
a. 4% Chlorhexidine Gluconate (Betasept, Hibiclens, Dyna-Hex4)
Apply product liberally to the surgical site and scrub for at least 2 minutes,
then blot dry
Repeat procedure for an additional 2 minutes and blot dry.
b. Hexachlorophene 3% (Phisohex)
Mix small amounts of sterile water with Phisohex causing it to lather.
Spread suds over operative site and scrub well for 3 minutes.
II Blot dry
Repeat 3 minute scrub and blot dry again
Rinse Phisohex from prepped skin after the procedure
c. Iodine Scrub/Soap 7.5%
Wet skin with water, apply enough iodine scrub to create lather and scrub for
Surgical Skin Preparation
Page 2
5 minutes. Blot or rinse off using sterile towel or gauze
d. Iodine Paint 10%
Paint area to be prepped with solution and allow to dry prior to starting
procedure.
e. Duraprep/Chloroprep
Hold sponge downward and press cap end of applicator.
Beginning at incision, and working outward, paint a single uniform coat of
solution on the skin.
If pooling occurs, immediately blot with a sponge applicator.
Allow the solution to dry thoroughly, 3 minutes, before draping.
Sterile gloves to be worn during prep.
f. Betadine Gel
One-step application is acceptable. Begin to prep at incision site and work
outward.
Gel needs to be in contact with skin for at least one minute; blotting is not
necessary, however if you choose to blot wait at least one minute after
application to do so.
g. Cetaphil
Can be used with or without sterile water.
03
When used without water apply to skin and rub gently outward from incision,
blot dry.
When used with water, mix small amount of cetaphil with water, rub gently
outward from incision site, rinse, blot dry.
Procedure Point of Emphasis
Abdominal Prep: Area Prepped: Nipple line to pubis.
1. RN Circulator turns back the patient's blanket and
gown to expose area to be prepped. Check to see
that safety strap is secured.
2. Turn on the OR spotlights and center on the
operative site.
3. Open sterile supplies on Prep stand in aseptic
manner. (Prep tray with solutions.)
4. RN Circulator don's sterile gloves and places two
towels along side of abdomen.
5. Use cotton-tipped applicator to clean umbilicus.
Discard applicator in trash container.
6. Using prep solution of surgeons preference and
saturated sponge, the RN Circulator covers the
entire prep area, beginning at the incision site and
extending to the periphery. All prep solutions will
be used according to manufacturer's
recommendations.
7. Apply a second application if appropriate,
beginning at the area of the intended incision and
extending to the periphery.
Be sure linen and gown are out from under the patient
to prevent pressure points and area for solutions to pool.
Lights are in readiness for the case. Assure lights are
working.
Place stand within easy accessibility.
Excess prep solution collects on towels and not under
patient. Use sterile cloth towels or towels provided in
tray.
Umbilicus is considered a "dirty" area and should be
cleaned prior to the surgical prep.
Prep solutions are used according to manufactures's
recommendations to allow for maximum antimicrobial
action.
Be sure not to bring sponge back to center once it
reaches the periphery. Use a second sponge if needed.
Surgical Skin Preparation
Page 3
Procedure
8. Blot area when applicable by placing blotting
towel from sterile prep tray over entire surface of
prep. Blot with gentle pressure, then peel towel
off, starting with edge farthest away from
circulating nurse and peeling back toward nurse.
Vaginal Procedures:
1. After the patient is in position, open the prep set
and don sterile gloves.
2. Place sterile towel under buttocks, leaving cuffto
protect sterile gloves. Another towel is placed
above umbilicus.
3. Using first soap sponge, scrub lower abdomen,
mons pubis, vulva, perineum and left upper % of
thigh use prep solution according to
manufactuer's recommendation. Discard sponge.
4. Using second sponge, scrub the mons pubis,
vulva, perineum and right upper % of thigh for
two minutes. Discard sponge.
5. Another sponge is used to scrub lower pOliion of
right and left thighs and anal area.
6. Complete vaginal prep by using prep sticks or
sponges on sponge sticks. Use circular motions
until vaginal vault is cleaned. Dry vagina with
dry sponge.
7. Cover prepped area with sterile towel and pat
with towel to absorb solution and remove
carefully.
8. If using povidone-iodine paint solution, paint all
areas described in steps number three through
six.
9. Catheterize patient at the end of the vaginal prep.
Labia are kept open with gloved hand while the
other inserts the catheter.
10. Remove towels and discard in appropriate
receptacle.
Extremity Prep:
1. Inspect hand/foot and nails for blood or diti.
Clean if necessary.
2. Remove rings and patient identification band from
surgical arm/leg if necessary. Replace ID band
on opposite extremity. Remove ring; place in
plastic bag and label with patient ID. Send to
P ACU or patient care unit with patient.
Point of Emphasis
Peeling towel back toward nurse keeps unsterile arms
over the sterile towel and avoids contamination of
prepped area.
See "positioning" procedure for details.
03
Keeps gloves sterile; towel or plastic drape keeps linen
under patient dry.
Do not scrub anal area. This is a "dirty" area and will
be completed last.
Both thighs should be included in this prep to extend
sterile field for the procedure.
Keeps "ditiy" sponge from returning to surgical site.
Dry to keep solutions from pooling in vagina. Surgeon
may request alternate solution.
Removes solution from area. Do not drag towel across
site.
A fresh, clean sponge stick is used for each step.
Surgeon may request paint only.
New sterile gloves are used when the catheter remains
in place for the case. Surgeon may place catheter
during case.
Keeps area free from wet towels and allows surgeon to
drape area.
Hand/foot may contain blood or dirt from injury. Clean
with scrub brush for tough stains.
Articles will be in surgical field. To prevent loss of
items, care is taken to document the location of the
item.
Surgical Skin Preparation
Page 4
Procedure
3. Open prep set on prep stand and don sterile
gloves.
4. When applicable, surgeon will place an
impermeable drape around proximal aspect of
extremity.
Arm:
1. Begin scrubbing at incision
site moving to periphery.
2. Scrub continues until entire surface to be prepped
has been covered. Repeat if applicable
according to manufacturer's recommendations.
3. Entire arm is maintained off of bed until scrub is
complete and sterile drape has been placed.
Leg:
1. Starting at area of planned incision, RN
circulator uses prep solution and sponge and
proceeds circumferentially until entire leg is
scrubbed.
2. Repeat with second sponge, if applicable.
3. Keep leg elevated until sterile drapes can be
placed.
Approved by:
Point of Emphasis
Keep trash recepticle close to field for disposition of
sponges.
Delineates prep field
Scrub begins close to the incision area: axilla is
considered "dirty" and completed last.
03
Sponge never returns to area previously scrubbed. Use
new sponge as needed.
Lowering arm would contaminate prepped area.
Entire leg is prepped by scrubbing around leg; prevents
moving sponge back over prepped area.
Never return sponge to area already scrubbed. Use new
sponge as needed.
Date
Nonna Tomlinson, RN, MSN, NE-BC, FACHE
Associate Vice President! Associate Executive Director
Revised by: Nancy Gauger, RN, MSN, CNOR/ Ryan A. Kelso, R.N.
Approved: 3/1999
Reviewed: 7/2002
Revised: 6/2005,6/2008, 12/28/2010
Reviewed by Policy & Standard Committee, 12/10.
References: "Recommended Practices for Skin Preparation of Patients", AORN Standards and Recommended Practices for Perioperative
Nursing, 2002 (Denver, Assoc. of Operating Room Nursing, Inc., 2002)
Meeker Ruth, M., Rothrock, J.C. Alexander's Care of the Patient in Surgery, II tll edition, (St. Louis: Mosby Year Book,
1999)