Skin Prep Flashcards
Skin prep renders the skin?
surgically clean not sterile
- Transient organisms
- Resident organisms
Skin prep considerations:
. Hair removal if indicated should occur as close as possible to the time of the planned procedure; shaving is done outside the OR(pre-op)
. Skin prep is done last, and prior to draping
. Gross soil and skin oil should be removed
. Consider patients allergy
. Prep surrounding areas first and contaminated areas last (except the umbilicus)
. Prep is initiated at the planned incision site and carried toward the periphery using a widening circular motion
. Limbs are circumferentially prepped
. Once boundaries/periphery of the prep has been reached, the sponge should be discarded and not brought over the clean area
Types of Skin Prep Solutions:
. Iodine
. Iodophors: Iodine + detergent solution, Betadine (povidone iodine)
. Triclosan
. Alcohol 70% (Isopropyl)
. Chlorhexidine
. Hexachlorophene (Phisoderm; Phisohex)
. Duraprep
Iodine
. Cytotoxic to microorganisms
. May be combined with water or alcohol
. Skin irritant
Iodophors
. Iodine + detergent solution
. Betadine; povidone iodine
Less likely to cause irritation, non toxic
Triclosan
. antibacterial and antifungal agent
. Safe to use around the eyes
. surgical cleaning treatment
Alcohol 70% (Isopropyl)
. Provides rapid and significant in reduction of microbes
. Usually combined with another prep solution
. Should not be used on mucous membranes and open wounds
. Causes skin dryness and flammable
. Do not use with lasers
Chlorhexidine Ex. Hibiclens
. Provides longer residual effect (4hours)
. Less irritating
. Used in patients who have allergies to iodine
Hexachlorophene (Phisoderm; Phisohex)
. Less irritating
. Has a cumulative effect after being used over a period of frequent use
Duraprep
. Self contained prepping solution
. Contains Iodophors for long lasting anti microbial properties and alcohol for its rapid effect
Most common Abdominal and Thoraco abdominal Prep
. Prep boundaries:
- Mid chest to bilateral thighs
. Umbilicus is cleaned first
. Prepped up to/ near the level of the table edge
Chest and Breast
. Arm of the affected side is elevated
. Areas :
- shoulders
- Upper arm
- Elbow
- Axilla
- Neck, lower jaw
- Chest up to table line
Eyes, Ears, Face and Nose
. Use eye protection
. Plastic eye shields are preferred
. Prep should always extent to the hairline
Extremities
. An assistant should elevate the limb with a sterile gloves
. Extremity is prepped around its entire circumference
Prep boundaries:
. Foot and ankle procedures:
- Foot and entire leg from ankle to knee
. Bilateral leg procedures:
- Both legs from toes to waist
. Hip procedures:
- Abdomen of affected side, entire leg and foot, buttocks groin and pubis
. Hand procedures:
- Hand and arm to 3 inches above the elbow
. Shoulder procedures:
- Base of the neck, shoulder scapula, chest to midline and circumference of upper arm down to the elbow
. Arm procedures:
- Entire arm, shoulder and axilla including hand with fingers
Perineal and Vaginal Prep
. Should begin in the pubic area towards the genitalia and perineum
. Sponges should be discarded after going into the anus
. 2 prep sets are used for abdominal perineal procedures
