Preoperative skin preparation

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Preoperative skin preparation

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

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Preoperative Skin PreparationNursing
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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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 fornaiös
• 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

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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

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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

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Surgical scrub General consideration