Skin Asepsis

Question 1

What is an SSI?

Answer 1

An infection that occurs after surgery in the part if the body where surgery took place

Question 2

Goal of skin asepsis?

Answer 2

Reduce the patients risk of developing an SSI by removing soil and transient microorganisms at the surgical site and surrounding area

Question 3

Skin prep is done to?

Answer 3

Decrease resident microbial count as much as possible
In shortest amount of time
With least amount of tissue irritation
To prevent rapid rebound growth of microbes

Question 4

Skin and layers?

Answer 4

First line of defense against infection
- contains resident and transient flora

Break in skin = portal of entry

Epidermis = outer most 
Dermis = middle layer
Subcu = inner layer

Question 5

3 types of SSI’s?

Answer 5

Superficial incisional - epidermis/dermis/subcu

Deep incisional - fascial and muscle layers

Organ space

Question 6

Impact of SSI’s?

Answer 6

Cause of morbidity and mortality
Leading cause of readmission following sx

Impacts patients

• loss of wages/employment
• loss of function
• chronic health problems

Impacts facility

• loss of OR time
• increased readmission

Question 7

Risk factors for SSI?

Answer 7

Increased age
Smoking
Diabetes 
Malnutrition 
Poor understanding 

Emergency surgery
Degree of contamination on surgical site

Question 8

Prevention of SSI?

Answer 8

Patient education 
Shower night before sx
Intra op surgical skin prep 
Adherence to strict aseptic principles
Careful observation of sterile technique

Question 9

Pre op skin considerations?

Answer 9

Bathing decreses microbial skin contamination 
Allergies
Skin condition at surgical site
Jewelry
Surgical site marking
Hair removal 
Nutritional status

Question 10

Is there a correlation between seafood and iodine allergy?

Answer 10

Research has shown no correlation

It is safe to use povidone iodine

Question 11

Desired features of skin antiseptic products?

Answer 11

Applied quickly
Not irritating to skin
Not inactivated by other chemicals/body fluids
Single use
Coloured to increase visibility of prep 
FDA category 1

Question 12

What are FDA category 1 requirements?

Answer 12

Fast acting
Broad spectrum
Persistent
Decrease microbial counts

Question 13

4 common antiseptic products?

Answer 13

2% CHG/70% isopropyl etoh
2-4% water based CHG

Iodine / etoh
Iodine scrub/paint

Question 14

CHG / isopropyl alcohol?

Answer 14

Use a gentle back and forth motion
Apply to dry site for 30sec or moist site 2 min
Dry time 3 min
Dry time hair 1hr

Question 15

Water based CHG?

Answer 15

Use back and forth swabbing motion
Application time 4 min
Blot to dry

Question 16

Iodine/alcohol?

Answer 16

Paint in singke uniform application
No set application time
Dry 3min
Dry hair 1hr

Question 17

Iodine scrub/paint?

Answer 17

Use scrubbing motion to create lather
Paint after scrub in concentric circles 
Scrub 5min
Paint no set time
Rinse scrub with sterile gauze and blot dry
Paint until dry

Question 18

Fire prevention of skin products?

Answer 18

*fuel source
Do not heat products 
Clip hair 
Prevent pooling/soaking
Allow dry times

Question 19

Application of products?

Answer 19

Hair removal
Avoid prolonged contact to prevent chemical skin injury
Protect equipement
Remove ar end of procedure

Question 20

Can you dilute prep solutions?

Answer 20

No

Creates unknown concentrations and contamination

Question 21

Who does skin prep and why?

Answer 21

Applied by circulating nurse to prevent contamination

Use sterile gloves and supplies

Question 22

Applying prep to site?

Answer 22

Should be large enough to accommodate:
Shifting drapes
Extension of the incision
Additional incisions
All drain sites

Question 23

Documentation of skin prep?

Answer 23

Removal of jewlery 
Skin condition 
Who performed 
Products used 
Area prepped
Any reactions/injurys that occured

Question 24

Removal of head hair before surgery?

Answer 24

Surgeon will discuss with patient prior
Done as close to surgery time as possible
Hair removed is property of patient
- contain, label and place in belongings bag

Question 25

Scalp prep?

Answer 25

Protect eyes and ears

Comb hair away from surgical area and secure with non metallic ties, water based ointment or prep and cover with drapes

Question 26

Eye prep?

Answer 26

Product must be safe for eye use
- no ETOH/CHG
Iodine products must be labelled for ophthalmic use
Can use baby shampoo and balanced salt solution if iodine allergy

Clean eye lids and lashes with prep on q tip
Paint solution over eye from brow to mid cheek and nose to outer eye
Irrigate eye with NS

Question 27

Prepping for thyroid sx?

Answer 27

Chin to nipples
Anterior neck
Ear lobes to later aspect of shoulders

Place towels at each side of head to avoid pooling

Question 28

Prep for breast?

Answer 28

Back, thoracic area, neck shoulder, arm, axilla and chest

On back prep neck to hips
Neck and shoulder on side of surgery
Arm circumferentially
Chest neck to umbilicus and to bed side

Question 29

Abdominal prep?

Answer 29

Place towels to prevent pooling

Nipples to groin

Question 30

Abdo/peri prep?

Answer 30

Abdomen, pubis, vagina, perineum, anus and thighs adjacent to vagina

2 kits needed
Bladder emptied after vag prep

Always prep vagina first then abd
- pubis, thighs and then vagina

Question 31

Prep to extremity?

Answer 31

Use second team member
Drape tourniquet
Circumferentially from tourniquet down

Question 32

Where can iodine be found?

Answer 32

In thyroid hormones, amino acids and other substances

Question 33

Transient va resident bacteria?

Answer 33

Transient

• limited to exposed area of skin
• removed by mechanical cleansing

Resident

• inhabit deep structures of dermis
• require chemical agents to eliminate them and prevent regrowth

Question 34

How do we remove hair?

Answer 34

Clipping or depilatory

Question 35

Exposing area to be prepped?

Answer 35

Privacy
Site marking
6-8 inches beyond in case of drape movement or excision extension