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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Concepts Covered:

  • Shock
  • Shock
  • Immunological Disorders
  • Cardiac Disorders
  • Emergency Care of the Cardiac Patient
  • Integumentary Disorders
  • Neurological Trauma
  • Musculoskeletal Trauma
  • Liver & Gallbladder Disorders
  • Intraoperative Nursing
  • Neurological Emergencies
  • Oncology Disorders
  • Emergency Care of the Neurological Patient
  • Postoperative Nursing
  • Disorders of the Thyroid & Parathyroid Glands
  • Central Nervous System Disorders – Brain
  • Noninfectious Respiratory Disorder
  • Respiratory Emergencies
  • Hematologic Disorders
  • Vascular Disorders
  • Respiratory System
  • Infectious Respiratory Disorder
  • Urinary Disorders
  • Urinary System
  • Musculoskeletal Disorders
  • Acute & Chronic Renal Disorders
  • Emergency Care of the Trauma Patient
  • Disorders of the Adrenal Gland
  • Documentation and Communication
  • Preoperative Nursing
  • Legal and Ethical Issues
  • Cognitive Disorders
  • Medication Administration
  • Male Reproductive Disorders
  • Sexually Transmitted Infections
  • Disorders of Pancreas
  • Newborn Complications
  • Communication
  • Lower GI Disorders

Study Plan Lessons

Sepsis Concept Map
Shock
Shock Module Intro
Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)
Signs of Osteoarthritis Nursing Mnemonic (OSTEO)
Sinus Bradycardia
Sinus Tachycardia
Skin Cancer
Spinal Cord Injury Case Study (60 min)
Spinal Precautions & Log Rolling
Sprains and Strains – Nursing Care Nursing Mnemonic (RICE)
Stages of Hepatitis Nursing Mnemonic (PIP)
Sterile Field
Sterile Gloves
Stoke Assessments Nursing Mnemonic (FAST)
Stomach Cancer (Gastric Cancer)
Stroke (CVA) Module Intro
Stroke Assessment (CVA)
Stroke Concept Map
Stroke for Certified Emergency Nursing (CEN)
Stroke Nursing Care (CVA)
Stroke Therapeutic Management (CVA)
Surgical Incisions & Drain Sites
Surgical Prep
Surgical Counts for Certified Perioperative Nurse (CNOR)
Sympatholytics (Alpha & Beta Blockers)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Tension and Cluster Headaches
Tetracycline (Panmycin) Nursing Considerations
The 5-Minute Assessment (Physical assessment)
Thoracentesis
Thrombocytopenia
Thrombolytics
Thromboembolic Disease- Deep Vein Thrombosis (DVT) for Certified Emergency Nursing (CEN)
Thyroxine (T4) Lab Values
Thyroid Stimulating Hormone (TSH) Lab Values
Total Iron Binding Capacity (TIBC) Lab Values
To Clot or Not To Clot – Anticoagulants! – Live Tutoring Archive
Trach Care
Trach Suctioning
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Troponin I (cTNL) Lab Values
Tuberculosis (TB) Case Study (60 min)
Urinary Elimination
Urinary Tract Infection Case Study (45 min)
Vancomycin (Vancocin) Nursing Considerations
Vent Alarms
Ventilator Settings
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V-tach)
Vessels & Fluid
Vitamin D Lab Values
Warfarin (Coumadin) Nursing Considerations
Wound Care – Assessment
Wound Care – Selecting a Dressing
Wound Care – Dressing Change
Wound Care – Wound Drains
Wound Infections for Certified Emergency Nursing (CEN)
Wounds (Infectious, Surgical, Trauma) for Progressive Care Certified Nurse (PCCN)
Wound Dressing Maintenance for Certified Perioperative Nurse (CNOR)
Wound Classification for Certified Perioperative Nurse (CNOR)
Who Needs Dialysis Nursing Mnemonic (AEIOU)
Wound Bleeding (Uncontrolled External Hemorrhage) for Certified Emergency Nursing (CEN)
02.14 Shock Stages for CCRN Review
1st Degree AV Heart Block
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
ACE (angiotensin-converting enzyme) Inhibitors
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Acute Kidney Injury Case Study (60 min)
Acute Renal (Kidney) Module Intro
Addisons Assessment Nursing Mnemonic (STEROID)
Addisons Disease
Adjunct Neuro Assessments
Admissions, Discharges, and Transfers
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
Advance Directives
Adrenal Gland Hormones Nursing Mnemonic (The 3 S’s)
Airway Suctioning
Allergic Reactions and Anaphylaxis for Certified Emergency Nursing (CEN)
Alteplase (tPA, Activase) Nursing Considerations
Altered Mental Status Nursing Mnemonic (AEIOU TIPS)
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Amputation
Amputation Concept Map
Anemia for Progressive Care Certified Nurse (PCCN)
Anesthetic Agents
Anesthetic Agents
Anti-Infective – Sulfonamides
Anti-Infective – Tetracyclines
Anti-Infective – Antitubercular
Anti-Platelet Aggregate
Anticonvulsants
Antidiabetic Agents
Antimetabolites
Antineoplastics
Antinuclear Antibody Lab Values
Aortic Aneurysm – Management Nursing Mnemonic (CRAM)
ASA (Aspirin) Nursing Considerations
Aspiration for Certified Emergency Nursing (CEN)
Asthma (Severe) for Progressive Care Certified Nurse (PCCN)
Asthma for Certified Emergency Nursing (CEN)
At Risk for Gout Nursing Mnemonic (MALE)
Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atrial Fibrillation (A Fib)
Atrial Flutter
Azithromycin (Zithromax) Nursing Considerations
Barriers to Health Assessment
Blood Flow Through The Heart
Blunt Chest Trauma
Bowel Obstruction Concept Map