Surgical Prep Objectives Know the indications and contraindications

Surgical Prep

Objectives � Know the indications and contraindications of various prep types. � Describe prepping patterns for various body sites � know where to find guidelines for use of various surgical preps.

� The Purpose of the prep is to render the surgical site as free as possible from infectious organisms.

Prepping for Prep � Hair Removal should as close to the time of surgery as possible without actually being done in the OR � Patients are asked to shower the night before surgery and may be given CHG wipes to use at home. � If the area is visibly dirty you may want to consider washing it with soap and water prior to the final surgical prep. � Consider “contaminated” areas like fingernails, toes, skin fold and the umbilicus.

Types of Prep Chlorhexidine Gluconate (2%) and Et. OH(70%) � Antibacterial action lasts up to 4 hours � Effectiveness decreased by the presence of soaps, rinse thoroughly if pre-washing. � Not absorbed through intact skin � Ototoxic and an Eye irritant, should no be used on the face.

e. g. Chloraprep � Flammable while wet 3 minutes to dry � May cause irritation on infants <2 months � Effective area 13. 2”x 13. 2”

Types of Prep Betadine (povidine iodine) � Works well alone or when combined with soaps � Virtually non-irritating to mucous membranes (5% sol’n OK for eye prep) � Should be left on skin at least 2 minutes. � OK to use on infants >2 months

Povidone Iodine Scrub/Paint

Types of Prep Iodine & Et. OH e. g. Duraprep � Cannot be used on face or in eyes due to alcohol content � Does not wash off, use “remover lotion” after case � Use with caution on infants <2 months.

Types of Prep Hibiclense (CHG) � Used in cases of iodine allergy where chloraprep is not possible. Eg, broken skin, mucous membranes. � Not necessary to dilute

Types of Prep Castille Soap � When you can’t use any other kind of prep due to sensitivities. � Comes in concentrated packs � Scrub with soapy water and rinse � Ok to use in vaginal prep

Prepping Theory � Clean Dirty � Start with Surgical site � Do not re-do an area

Special Cases: Eyes � No more than 5% betadine (no soap) � Do not clip or shave eyebrows � Start from where eyelids meet extend outward � Make sure prep contacts eyelashes.

Special Cases: Mouth � Usually Peridex, Betadine can be used. � Provide toothbrush � Mouth cases will always be considered “contaminated

Quiz: Which Prep? � ORIF closed ankle fracture � Delayed primary closure of traumatic abdominal wound. � Laparoscopic appendectomy � Pyloromyotomy on a 6 week old infant � Cataract surgery � Laparoscopic assisted vaginal hysterectomy � Facial laceration on pt with shellfish allergy

Post –Op Do I wash off this prep? � Betadine � Chrloroprep � Duraprep � Hibiclense � Castille Soap