02.06 Surgical Prep

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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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