1005 Surgical Site Skin Preparation 

1005

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IFPN Guideline
for
Skin Preparation of the Surgical Patient.


Scope of Guideline:
The practice environment where the surgical patient is treated.

Scope of Responsibility:
Medical, nursing or clinical staff undertaking the patient skin prep.

Rationale/Purpose:
To reduce the potential for post-operative wound infection by comprehensive cleansing and disinfection of the patient's skin prior to surgical intervention.


GUIDELINE:


GUIDELINE 1

THE OPERATIVE SITE AND SURROUNDING AREAS ARE CLEAN Criteria
1.1 Dirt and debris are removed before patient arrival in the operating room by as appropriate : -

? Patient shower or sponge
? Cleansing the operative site

Rationale

Removal of superficial soil, debris and transient microbes before applying the anti-microbial agent(s) reduces the risk of wound contamination by decreasing organic debris on the skin


1.2 Assessment and documentation of the operative site is made before the skin is surgically prepared eg.:-

? Skin integrity
? Presence of lesions - moles, warts, rashes etc

Rationale

Inadvertent removal traumatises the skin and creates potential for wound colonisation by micro-organisms


1.3 Hair removal from operative site occurs only if necessary. Determining factors include: -

? Amount of hair
? Location of incision
? Type of surgical procedure to be performed
2

1.4 Where hair removal is indicated the removal is performed: -

? According to the surgeons orders or facility policy
? By skilled personnel
? In a manner that ensures skin integrity is preserved
? Clippers and/or depilatory agents are recommended (skin testing is required before using depilatory agents)
? Shaving is undertaken only when other methods not available - wet shaving is preferable
? As close to the time of surgery as possible
? To minimise the time available for wound colonisation of micro-organisms at the surgical site


GUIDELINE 2

THE OPERATIVE SITE IS PREPARED WITH AN ANTI-MICROBIAL AGENT

Criteria

2.1 The anti-microbial agent should have a broad range of germicidal action spectrum, be non-toxic and provide residual protection.


2.2 Selection of the anti-microbial agent is based on: -

? Patient sensitivity
? Anti-microbial agents used on skin with a known hypersensitivity reactions may cause adverse patient outcomes - agents may be absorbed by skin or mucous and cause toxic reactions
? Skin condition at operative site eg.
? Burn site - normal saline
? Colostomy site - isolated or covered with anti-microbial soaked sponge
? Mucous membranes - anti-microbial agent or antiseptic agent only



GUIDELINE 3

SKIN PREPARATION IS PERFORMED BY SKILLED PERSONNEL
Criteria
3.1 Skin preparation requires consideration of: -

? Length of initial incision
? Requirement to extend initial incision and/or make additional incisions
? Drain sites required
? Drape fenestration size
? Preservation of skin integrity
? Maintenance of aseptic technique
? Prevention of pooling/reduction of hazards
3

GUIDELINE 4

SKIN PREPARATION IS DOCUMENTED IN THE PATIENTS RECORD

Criteria

4.1 Record of skin preparation may include but is not limited to: -

? Skin condition/cleanliness
? Hair removal (if performed) including method of removal and area
? Skin preparation used i.e. cleansing agent, solvent, antiseptic agent
? Person undertaking the prep
? Onset and details of any hypersensitivity reactions

GUIDELINE 5

Guidelines for skin preparation are included in a readily accessible Unit Practice Manual and are reviewed at least annually.

References:
PNANZ Guidelines for Safe Practice
ACORN Standards Guidelines & Policy Statements
AORN Recommended Practices & Guidelines

1. J S Garner, “Guideline for isolation precautions in hospitals,” Infection Control and Hospital Epidemiology 17 (january 1996) 55.
2. Ibid, 63.
3. “Occupational exposure to bloodborne pathogens; Final rule,” Federal Register 56 (Dec 6, 1 991), 641 76.
4. Garner, “Guideline for isolation precautions in hospitals,” 61
5. 1 L Gerberding, “Procedure-specific infection control for preventing intraoperative blood exposures,” American journal of Infection Control2l (December 1993) 365-366.
6. Ibid, 366.
7. Ibid.
8. “Occupational exposure to bloodborne patho¬gens; Final rule,” 6411 8.
9. Ibid.
10. Ibid. 64122.
11. lbid,64118-64119.
12. lbid, 641 75-641 76.
13. D J Weber, K K Hoffmann, A Rutala, “Manage¬ment of the healthcare worker infected with human immunodeficiency virus: Lessons from nosocomial trans¬mission of hepatitis B virus,” Infection Control and Hos¬pital Epidemiology 12 (October 1991) 628.
14. “AORN revised statement on the patient and health care workers with human immunodeficiency virus (HIV) and other bloodborne diseases,” in Standards, Rec¬ommended Practices, and Guidelines (Denver: Associa¬tion of Operating Room Nurses, mc, 1999) 121.
15. Centers for Disease Control, “Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures,” Morbidity and Mortality Weekly Report 40 (July 12, 1991)2.
16. “Occupational exposure to bloodborne pathogens; Final rule,” 641 56.
17. Garnei; “Guideline for isolation precautions in hospitals,” 65.
18. Centers for Disease Control, “Guidelines for pre¬venting the transmission of Mycobacterium tuberculosis in health-care facilities,” Morbidity and Mortality Weekly Report 43 (Oct 28, 1994) 54242, 54303.
19. Garner, “Guideline for isolation precautions in hospitals,” 65-66.
20. Garner, “Guideline for isolation precautions in hospitals,” 65-66; “New isolation guidelines written to ease confusion,” OR Manager 11 (March 1995) 22.
21. Garner, “Guideline for isolation precautions in hospitals,” 63, 68.
22. lbid, 62.
23. Ibid, 64.
24. lbid, 55.
25. “Occupational exposure to bloodborne pathogens; Final rule,” 641 75.
26. V Fox, “Passing surgical instruments, sharps with¬out injury,” (Clinical Issues) AORN journal 55 (January 1992) 264-266; Garner, “Guideline for isolation precau¬tions in hospitals,” 69.
27. Centers for Disease Control, “Guidelines for pre¬venting the transmission of Mycobacterium tuberculosis in health-care facilities,” 9.
28. Garner, “Guideline for isolation precautions in hospitals,” 55.
29. Ibid.
30. Ibid.