Surgical Prep
Included In This Lesson
Outline
Overview
- Purpose of surgical prep
- Prevent organisms to enter surgical site
- Prevent surgical site infection (SSI)
- Methods include
- Preoperative bathing
- Surgical site prep (antiseptic)
- Clean incision at and around site
- Methods vary
- Hair guidelines
- Remove or retain
- Prevent organisms to enter surgical site
Nursing Points
General
- Preoperative bathing
- Reduces bacterial count on skin
- Shower or bath with soap or antiseptic
- Night before or day of surgery
- Chlorhexidine gluconate
- Bath
- Cloth wipes
- Chlorhexidine gluconate
- Night before or day of surgery
- Follow facility protocol
- Shower or bath with soap or antiseptic
- Reduces bacterial count on skin
- Surgical site prep
- Antiseptic
- Used immediately prior to surgery
- At and around surgical site
- Product selection
- Physician preference
- Healthcare organization approved
- Based on
- Ability to decrease microbials rapidly
- Quick application
- Remain effective throughout surgery
- No irritation or contraindication to patient
- Physician preference
- Antiseptic types
- Follow manufacturers guidelines
- Chlorhexidine gluconate
- Povidine-iodine 5% – 10%
- Iodine topical solution
- Ophthalmic betadine solution
- Combinations
- Follow manufacturers guidelines
- Antiseptic
- Hair at surgical site
- Should not be removed
- Unless interferes with surgery
- Clip only
- Do not shave
- No razor!
- Increases risk of SSI
- Immediately prior to surgery
- Decreases irritation
- Do not shave
- Should not be removed
Assessment
- Review patient allergies
- Assess surgical site
- Remove body jewelry
- Harbor bacteria
- Remove body jewelry
- Nursing documentation
- Prepped area
- Antispetic agent used
Therapeutic Management
- Prepping process
- Sterile gloves worn
- Surgical site without contaminated area
- Prep point of incision out to periphery
- Contaminated area involved
- Stoma/vagina/anus
- Cleaned separately
- Sponge used once then discarded
- Work from cleanest to least clean
- Stoma/vagina/anus
Nursing Concepts
- Infection control
- Patient-centered care
- Safety
Patient Education
- Teach patient
- Do not shave before surgery
- Can cause irritation
- Follow bathing instructions
- Remove all jewelry
- Ask questions!
- Do not shave before surgery
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 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.
NCLEX
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