Preoperative skin

preparation
Dr. Aidah Abu Elsoud Alkaissi
An Najah National University
Faculty of Nursing

Dr. Aidah Abu Elsoud Alkaissi

Division of Intensive Care

Preoperative Skin Preparation

Nursing Consideration

The preoperative skin preparation of a surgical patient is the first

step in the prevention of wound infection
The nurse should explain the purpose and method of the
procedure
Every effort should be made to allay any fears the patient may
express and to answer questions in a reassuring manner
During the procedure the nurse should observe the patients
general condition, particularly the condition of the skin under
treatment
Any contraindication to the procedure should be documented
Provide the comfort, safety and privacy of the patient
Good alignment of the patiemts body should be maintained and
special supports for positioning shoild be used as indicated

Dr. Aidah Abu Elsoud

Initial preparation of operative

area

In the immediate preoperative period, the skin of the involved

part of the body is prepared by special cleansing
Hair should be removed from the operative site only as necessary
Three alternatives for hair removal are clipping, use of depilatory
and wet shaving
Studies show that the wound infection rate is considerably higher
for patients who are shaved preoperatively than for patients who
have no preoperative shave preparation or a small amount of hair
clipped or for patients on whom a depilatory is used
If a shave is ordered by the surgeon, the patient should be
shaved immediately before surgery, preferably in a holding area
within the surgical suite that afford privacy and is equipped with
good lighting facilities

Dr. Aidah Abu Elsoud

Initial preparation of operative

area

The amount of time between the preoperative shave and the

operation has a direct effect on the wound infection rate
In shaving the site, great care should be taken to avoid
scratching, nicking or cutting the skin because cutaneous
bacteria will proliferate in these areas and increase the chances
of infection
Specific orders for the skin preparation are written by the
surgeon
A manual with diagrams and instructions concerning the
preoperative skin shave is useful for the guidance and
information of the personnel to whom the task is delegated
The extent of area to be shaved is determined by the site of
the incision and the nature of the operation

Dr. Aidah Abu Elsoud

Initial preparation of operative

area

Shaving the face and neck of children or female

patients is rarely necessary
The eyebrows are not shaved unless specifically
ordered by the physician
The head and neck are not generally prone to
wound infection because of the generous blood
supply to this area
For cosmetic and psychological reasons, preparation
for head and neck surgery may be done in the
operating room after the induction of anaesthesia
Dr. Aidah Abu Elsoud

Initial preparation of operative

area

For the orthopedic surgery on the extrimities, the shave

preparation usually extends from one joint above to one joint
below the area of incision
If a pneumatic tourniquetwill be used during surgery, the entire
extremity may be prepared to facilitate proper draping technique
Preparation and draping of the entire extrimity also permit
manipulation of the limb during surgery
Greate care should be exercised in the preparation for surgery on
bones because wound infection resulting from improper cleansing
may cause a stubborn condition leading to crippling, disfigurement
and permanent dysfunction
The skin may be difficult to clean if it has been affected by casts,
splints or brces that interfere with normal skin care or cause skin
damage

Dr. Aidah Abu Elsoud

Initial preparation of operative

area

Daily soaking may help to clean badly soiled feet in preparation

for surgery justas daily washing is advisable in preparation for
general elective surgery

Patients with traumatic injuries that may be

excessively painful such as fracture, burns and soft
tissue lacerations may require anesthesia for skin
preparation
Traumatic wound usually require copious irrigationto
flush out foreign matter
In cleansing the injured area, the surriounding skin is
first carefully washed with an antimicrobial detergent
The open wound is irrigated with an isotonic solution
and the area is treated with an antimicrobial solution

Dr. Aidah Abu Elsoud

Initial preparation of operative

area

If a patient must e shaved in the operating

room, a clippings and epithelium removed by
the razor
Skin preparation in the operating room has the
disadvantages that the patients anesthesia
time is prolonged , optimum useof the
operating room is infringed on, loose hair
remaining on the surrounding linen may get
into the wound and water used to wash the
skin can result in sterile drapes becoming wet
Dr. Aidah Abu Elsoud

Procedure for preoperative

shave

Individual supplies are used for each patient

Disposable preparation trays and razors can help
ensure a safe personal technique
The use of disposable gloves is a safeguard for the
pat and for the worker
Blankett and support for the patients position,
necessary lighting and handwashing facilities Basic
essential for shaving the site of incision are vailable
Basic equipment includes gloves, basins for warm
water and soap , a disposable razor, sponges for
washing, and towels or water proof for daping
Dr. Aidah Abu Elsoud

Procedure for preoperative shave

Solvent solution may required to remove adhesives ir nail polsh

Volatile liquais such as alcohol and aceton should be strictly
regulated because of the danger of fire or burns
Antimicrobial soap or detergent should be applied to the skin
areas using sponges moistened with water
A lather is created by using circular motion and light friction
Beggining with the proposal site of incision and working
towardthe periphery of the area
The principle is progression from cleansed areato unclensed one
Sponges are discarded as they become soiled and the process is
contined with fresh sponges
Application of lather to skin hair for several minuetes before
shaving enables the keratin of the hair to absoeb three to four
times its weight in water
The water absorbtion makes the hair softer and easier to shave

Dr. Aidah Abu Elsoud

Procedure for preoperative shave

A disposable razor with a sharp blade is used to shave off

lathered hair
Holding the soft areas and loose skin taut (pulled or drawn tight)
with the free hand rises the hair and permits easier access to
the area
A clean shaved can be obtained without injury to the skin by
gently stroking in the direction of hair growth
Nicks and cuts resulting from the shave should be reported as
incidents, and the surgeon should be notified
The surgeon may be ordered a 5-minutes scrub of the prepared
area with an antimicrobial soapor detergent after it has been
shaved
If so the shaved area is scrubed and rinsed carefully and the
skin is blotted dry to prevent chapping (To cause (the skin) to
roughen, redden, or crack) and irritation

Dr. Aidah Abu Elsoud

Final skin disinfection of operative area

After the patient has been positioned on the

operating room bed, final skin cleansing and
disinfection are performed
If the patient has not shower with an antimicrobial
detergent or soap immediately before leaving for
the operating room
The operative area may be prepared with an
antimicrobial scrub solution
While this is being carried out, the shave can be
inspected and touched up or extended as needed
Skin cleansing is followed by preparing with an
antimicrobial solution
Dr. Aidah Abu Elsoud

Prodeure for final skin preparing

Supplies arrange on a separate sterile prepping (Informal

Preparation) table
The items should include stainless steel cups for the cleansing
agent and the selected antimicrrobial agent, sterile sponges and
sponge holding forceps
Cotton tipped applicator are needed to clean the umbilicus
thouroughly and a scrub brush may be required fornais
Final skin disinfection may be done by the circulatin nurse or the
surgeon
The skin scrub begins at the line of the proposed incision and
proceeds to the periphery of the area
The antimicrobial agent is applied by sponges held in sponge
holding forceps or in the gloved hand

Dr. Aidah Abu Elsoud

Prodeure for final skin preparing

The gloved hand method requires that the glove be sterile at the
beggining of the skin scrub and that the surface of the patients
skin not be permitted to come into contact with the gloved hand
The sponges used in scrubbing are duscarded as they become
soiled and fresh one are taken
A soiled sponge is never brought back over a scrubbed surface
The lather is wiped off with dry, sterile sponges
Depending upon the surgeons preference, an antimicrobial
tincture, or paint may be carefully applied, avoiding any pooling
beneath pat
All wet draped should be removed from the patient area after the
skin scrub is complete

Dr. Aidah Abu Elsoud

Prodeure for final skin preparing

Sponges used to cleanse or disinfect a wound,

sinus, ulcer, intestinal stoma, the vagina, or the
anus are applied once to that area immediately
discarded
After prepping of the area, intestinal fistulas are
generally walled off, using one of the plastic
transparent adhesive drapes
Open wounds and body orifices are potentially
contaminated areas and as such are prepped after
the peripheral intact skin is cleansed
The surgical principle is always to scrub the
cleanest area first
Dr. Aidah Abu Elsoud

Surgical scrub
General consideration

Dr. Aidah Abu Elsoud