Surgical Prep

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Outline

Overview

  1. Purpose of surgical prep
    1. Prevent organisms to enter surgical site
      1. Prevent surgical site infection (SSI)
    2. Methods include
      1. Preoperative bathing
      2. Surgical site prep (antiseptic)
        1. Clean incision at and around site
        2. Methods vary
      3. Hair guidelines
        1. Remove or retain

Nursing Points

General

  1. Preoperative bathing
    1. Reduces bacterial count on skin
      1. Shower or bath with soap or antiseptic
        1. Night before or day of surgery
          1. Chlorhexidine gluconate
            1. Bath
            2. Cloth wipes
      2. Follow facility protocol
  2. Surgical site prep
    1. Antiseptic
      1. Used immediately prior to surgery
      2. At and around surgical site
    2. Product selection
      1. Physician preference
        1. Healthcare organization approved
      2. Based on
        1. Ability to decrease microbials rapidly
        2. Quick application
        3. Remain effective throughout surgery
        4. No irritation or contraindication to patient
    3. Antiseptic types
      1. Follow manufacturers guidelines
        1. Chlorhexidine gluconate
        2. Povidine-iodine 5% – 10%
        3. Iodine topical solution
        4. Ophthalmic betadine solution
        5. Combinations
  3. Hair at surgical site
    1. Should not be removed
      1. Unless interferes with surgery
    2. Clip only
      1. Do not shave
        1. No razor!
        2. Increases risk of SSI
      2. Immediately prior to surgery
        1. Decreases irritation

Assessment

  1. Review patient allergies
  2. Assess surgical site
    1. Remove body jewelry
      1. Harbor bacteria
  3. Nursing documentation
    1. Prepped area
    2. Antispetic agent used

Therapeutic Management

  1. Prepping process
    1. Sterile gloves worn
    2. Surgical site without contaminated area
      1. Prep point of incision out to periphery
    3. Contaminated area involved
      1. Stoma/vagina/anus
        1. Cleaned separately
        2. Sponge used once then discarded
      2. Work from cleanest to least clean

Nursing Concepts

  1. Infection control
  2. Patient-centered care
  3. Safety

Patient Education

  1. Teach patient
    1. Do not shave before surgery
      1. Can cause irritation
    2. Follow bathing instructions
    3. Remove all jewelry
    4. Ask questions!

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Transcript

Hi guys!  Today I’m going to talk to you a little bit about surgical preps.

So what is the purpose of the surgical prep?  The surgical prep reduces microbials or organisms that can be on the surgical patient’s skin. Reducing these organisms can decrease the chance of them entering into the surgical site and decreases the risk of surgical site infections, which is a huge concern for our surgical patients!

So I’m going to dig a bit deeper into the different surgical prep methods that exist, but I just wanted to give you a quick glance at the most common methods of surgical preps first.  These include preoperative bathing, hair removal guidelines, and cleaning the surgical site with a prep or antiseptic.

Ok let’s look a little closer at preoperative bathing.  Guys it’s exactly as it sounds, the patient takes a shower or bath the night before or day of surgery with a specific type of soap or antispetic to reduce the bacteria on the skin.  A very common preoperative bathing antiseptic is known as chlorhexidine gluconate. The patient can bathe with this or it even comes in cleansing wipes. Now guys I just want to make sure I am giving you all of the information here…I want you to know that current evidence does not necessarily suggest that preoperative bathing decreases surgical site infections but it does reduce bacteria on the skin.  In spite of the evidence the CDC recommends having the patient bathe with an antiseptic preoperatively because their thought is the “benefits outweigh the harm.” Not all facilities do this so make sure you are aware of the policy at your facility.

So another surgical prep method and the most important is the prepping of the surgical site with an approved antiseptic.  This happens immediately prior to the initial incision in the operating room. The surgical site is prepped at and around where the surgeon will be operating.  There is a technique to prepping the surgical site and I will talk a little more about that on an upcoming slide.

Ok guys so there are many different types of antiseptics or “preps” that are utilized to clean the surgical site.  The type is picked by the surgeon which is based on a few different things including the ability of the prep to decrease microbials quickly, fast and easy application, and if there are any contraindications to the patient like an allergy.

Guys with all antiseptics definitely follow the manufacturers guidelines to ensure the prep is working to its expected potential!  A lot of these antiseptic preps have specific drying times so make sure you follow these. Some examples of antiseptics are chlorhexidine gluconate, povidone iodine, iodine topical solution, and combinations of these.  Often times they come in a prepared stick that has a tint to it so the person doing the prepping can see the area that has been cleaned.

Ok guys so hair removal is something that has been debated for many years…to remove or not to remove!  So the current guidelines state that hair should be kept in place unless it is interfering with the surgical procedure.  If the hair does in fact need to be removed it should be clipped only. Absolutely no razors should be used on your patient!  Shaving has shown to increase the risk of SSIs as it creates small breaks in the skin which can help organisms to enter the wound.

So it’s going to be important to assess the area where the patient is going to be prepped, make sure all jewelry has been removed before prepping because this harbors bacteria.  Also be sure that there aren’t any open areas or wounds because this could change the type of prep used or even determine if the patient’s surgery should be cancelled. Make sure you thoroughly document the area that is prepped and the antiseptic prep used.

Ok so let’s take a closer look at the prepping process.  The team member who is prepping will wear sterile gloves.  Guys I want you to be aware that different facilities have different guidelines for who is responsible for prepping.  Where I currently work the circulating nurse does the prepping but I have worked in other facilities where the scrub nurse will prep.  So in most situations the prepping will occur from the point of incision outward. I like to apply the prep in a circular fashion starting at the incision and moving outwards.  When a contaminated site, like a stoma or vagina is included in the prep, the prep is done slightly different. A sponge will be used specifically on the contaminated site, cleaned separately and then discarded.  So in these instances the prep will be done from the cleanest area to the least clean area.

So we want to teach our surgical patients a few things in regards to the surgical prep.  Make sure the patient knows to follow any bathing instructions and also not to shave the area that will be operated on!  Patients should know to remove all jewelry especially jewelry on or near the surgical site. And of course as always ask questions!

Ok guys so which nursing concepts can we apply to the surgical prep? Prevention of infection is the focus of the surgical prep and is patient-centered with the goal of keeping the patient safe.  

Ok let’s look at a few key points of the surgical prep.  The purpose of the surgical prep reduces organisms on the skin to decrease the risk of surgical site infections.  With preoperative bathing the patient showers or bathes with a specific antiseptic or soap to decrease skin microbials.  A common preoperative bathing antiseptic is chlorhexidine gluconate. Do not remove hair unless it impedes the surgery. Clip only immediately before surgery, do not shave the site. The surgical site antiseptic prep is used on the site immediately prior to incision in the OR. Common types of preps are chlorhexidine gluconate and topical iodine. When prepping the patient, prep from incision outward as long as there isn’t an area of contamination involved.  If a contaminated area is involved like a stoma, that area will be cleaned separately and in this instance clean from the cleanest area to the least clean area.

Okay guys I hope you enjoyed this lesson on the surgical prep!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing.

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Med-Surg Study Plan

Concepts Covered:

  • Shock
  • Cardiac Disorders
  • Vascular Disorders
  • Pregnancy Risks
  • Emergency Care of the Cardiac Patient
  • Medication Administration
  • Acute & Chronic Renal Disorders
  • Central Nervous System Disorders – Brain
  • Cardiovascular Disorders
  • Disorders of Pancreas
  • Disorders of the Thyroid & Parathyroid Glands
  • Postoperative Nursing
  • Intraoperative Nursing
  • Preoperative Nursing
  • Perioperative Nursing Roles
  • Circulatory System
  • Urinary System
  • Integumentary Disorders
  • Labor Complications
  • Eating Disorders
  • Respiratory System
  • Respiratory Disorders
  • Noninfectious Respiratory Disorder
  • Renal Disorders
  • Hematologic Disorders
  • Oncology Disorders
  • Immunological Disorders
  • Disorders of the Adrenal Gland
  • Disorders of the Posterior Pituitary Gland
  • Respiratory Emergencies
  • Infectious Respiratory Disorder
  • Oncologic Disorders
  • Neurological Trauma
  • Neurologic and Cognitive Disorders
  • Nervous System
  • Central Nervous System Disorders – Spinal Cord
  • Peripheral Nervous System Disorders
  • Emergency Care of the Neurological Patient
  • Neurological Emergencies

Study Plan Lessons

Norepinephrine (Levophed) Nursing Considerations
Vasopressin (Pitressin) Nursing Considerations
Nitroglycerin (Nitrostat) Nursing Considerations
Nitroprusside (Nitropress) Nursing Considerations
Hydralazine (Apresoline) Nursing Considerations
Verapamil (Calan) Nursing Considerations
Nifedipine (Procardia) Nursing Considerations
Losartan (Cozaar) Nursing Considerations
Lisinopril (Prinivil) Nursing Considerations
Propranolol (Inderal) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Heparin (Hep-Lock) Nursing Considerations
Streptokinase (Streptase) Nursing Considerations
Procainamide (Pronestyl) Nursing Considerations
Warfarin (Coumadin) Nursing Considerations
Epinephrine (EpiPen) Nursing Considerations
Enoxaparin (Lovenox) Nursing Considerations
Enalapril (Vasotec) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Digoxin (Lanoxin) Nursing Considerations
Captopril (Capoten) Nursing Considerations
Atorvastatin (Lipitor) Nursing Considerations
Atenolol (Tenormin) Nursing Considerations
Amlodipine (Norvasc) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Hypoglycemia
Nursing Care and Pathophysiology for Hyperparathyroidism
Discharge (DC) Teaching After Surgery
Surgical Incisions & Drain Sites
Postoperative (Postop) Complications
Post-Anesthesia Recovery
Intraoperative Nursing Priorities
Intraoperative (Intraop) Complications
Intraoperative Positioning
Sterile Field
Surgical Prep
Malignant Hyperthermia
Moderate Sedation
Local Anesthesia
General Anesthesia
Intubation in the OR
Preoperative (Preop) Nursing Priorities
Preoperative (Preop) Education
Preoperative (Preop)Assessment
Informed Consent
Perioperative Nursing Roles
Perioperative Nursing Course Introduction
Hypoparathyroidism
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Pressure Line Management
Hanging an IV Piggyback
Spiking & Priming IV Bags
IV Push Medications
Central Line Dressing Change
Drawing Blood
Starting an IV
Fluid & Electrolytes Course Introduction
Fluid Compartments
Fluid Pressures
Fluid Shifts (Ascites) (Pleural Effusion)
Isotonic Solutions (IV solutions)
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Potassium-K (Hyperkalemia, Hypokalemia)
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Calcium-Ca (Hypercalcemia, Hypocalcemia)
Chloride-Cl (Hyperchloremia, Hypochloremia)
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Phosphorus-Phos
ABG Course (Arterial Blood Gas) Introduction
ABGs Nursing Normal Lab Values
ABG (Arterial Blood Gas) Interpretation-The Basics
ROME – ABG (Arterial Blood Gas) Interpretation
ABGs Tic-Tac-Toe interpretation Method
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Alkalosis
Metabolic Acidosis (interpretation and nursing diagnosis)
Metabolic Alkalosis
ABG (Arterial Blood Gas) Oxygenation
Lactic Acid
Base Excess & Deficit
Hematology Module Intro
Nursing Care and Pathophysiology for Anemia
Nursing Care and Pathophysiology for Sickle Cell Anemia
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Thrombocytopenia
Oncology Module Intro
Leukemia
Lymphoma
Oncology Important Points
Immunology Module Intro
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Lyme Disease
Systemic Lupus Erythematosus (SLE)
Metabolic & Endocrine Module Intro
Addisons Disease
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Diabetes Mellitus (DM) Module Intro
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Diabetes Management
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Respiratory Course Introduction
Respiratory A&P Module Intro
Lung Sounds
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Respiratory Infections Module Intro
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology of Pneumonia
Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)
Oxygen Delivery Module Intro
Hierarchy of O2 Delivery
Artificial Airways
Airway Suctioning
Blunt Chest Trauma
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Chest Tube Management
Respiratory Procedures Module Intro
Bronchoscopy
Thoracentesis
Neuro A&P Module Intro
Neuro Anatomy
Impulse Transmission
Cerebral Metabolism
Blood Brain Barrier (BBB)
Neuro Assessment Module Intro
Levels of Consciousness (LOC)
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Nursing Care and Pathophysiology for Parkinsons
Brain Tumors
Encephalopathies
Miscellaneous Nerve Disorders
Stroke (CVA) Module Intro
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Stroke Assessment (CVA)
Stroke Therapeutic Management (CVA)
Stroke Nursing Care (CVA)
Seizure Causes (Epilepsy, Generalized)
Seizure Assessment
Seizure Therapeutic Management
Nursing Care and Pathophysiology for Seizure
Neurological Fractures
Spinal Cord Injury
Nursing Care and Pathophysiology for Meningitis
Cardiovascular Disorders (CVD) Module Intro
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Aortic Aneurysm
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Cardiac Course Introduction
HMG-CoA Reductase Inhibitors (Statins)
Cardiac Glycosides
Calcium Channel Blockers
Angiotensin Receptor Blockers
ACE (angiotensin-converting enzyme) Inhibitors
Renin Angiotensin Aldosterone System