Skin Asepsis Flashcards
What is an SSI?
An infection that occurs after surgery in the part if the body where surgery took place
Goal of skin asepsis?
Reduce the patients risk of developing an SSI by removing soil and transient microorganisms at the surgical site and surrounding area
Skin prep is done to?
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
Skin and layers?
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
3 types of SSI’s?
Superficial incisional - epidermis/dermis/subcu
Deep incisional - fascial and muscle layers
Organ space
Impact of SSI’s?
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
Risk factors for SSI?
Increased age Smoking Diabetes Malnutrition Poor understanding
Emergency surgery
Degree of contamination on surgical site
Prevention of SSI?
Patient education Shower night before sx Intra op surgical skin prep Adherence to strict aseptic principles Careful observation of sterile technique
Pre op skin considerations?
Bathing decreses microbial skin contamination Allergies Skin condition at surgical site Jewelry Surgical site marking Hair removal Nutritional status
Is there a correlation between seafood and iodine allergy?
Research has shown no correlation
It is safe to use povidone iodine
Desired features of skin antiseptic products?
Applied quickly Not irritating to skin Not inactivated by other chemicals/body fluids Single use Coloured to increase visibility of prep FDA category 1
What are FDA category 1 requirements?
Fast acting
Broad spectrum
Persistent
Decrease microbial counts
4 common antiseptic products?
2% CHG/70% isopropyl etoh
2-4% water based CHG
Iodine / etoh
Iodine scrub/paint
CHG / isopropyl alcohol?
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
Water based CHG?
Use back and forth swabbing motion
Application time 4 min
Blot to dry
Iodine/alcohol?
Paint in singke uniform application
No set application time
Dry 3min
Dry hair 1hr
Iodine scrub/paint?
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
Fire prevention of skin products?
*fuel source Do not heat products Clip hair Prevent pooling/soaking Allow dry times
Application of products?
Hair removal
Avoid prolonged contact to prevent chemical skin injury
Protect equipement
Remove ar end of procedure
Can you dilute prep solutions?
No
Creates unknown concentrations and contamination
Who does skin prep and why?
Applied by circulating nurse to prevent contamination
Use sterile gloves and supplies
Applying prep to site?
Should be large enough to accommodate: Shifting drapes Extension of the incision Additional incisions All drain sites
Documentation of skin prep?
Removal of jewlery Skin condition Who performed Products used Area prepped Any reactions/injurys that occured
Removal of head hair before surgery?
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
Scalp prep?
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
Eye prep?
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
Prepping for thyroid sx?
Chin to nipples
Anterior neck
Ear lobes to later aspect of shoulders
Place towels at each side of head to avoid pooling
Prep for breast?
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
Abdominal prep?
Place towels to prevent pooling
Nipples to groin
Abdo/peri prep?
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
Prep to extremity?
Use second team member
Drape tourniquet
Circumferentially from tourniquet down
Where can iodine be found?
In thyroid hormones, amino acids and other substances
Transient va resident bacteria?
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
How do we remove hair?
Clipping or depilatory
Exposing area to be prepped?
Privacy
Site marking
6-8 inches beyond in case of drape movement or excision extension
