Transcript Surgical Technology

Surgical Technology
Skin Preparation
DHJ 6/19/05
Objectives
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Purpose
Preliminary skin prep
Skin prep on O.R. table
Antiseptic solutions
skin prep risks
Basic prep general
guidelines
• Contaminated areas
• Special considerations in
specific anatomical areas
• Skin marking
• Documentation
Purpose of the skin prep
• Render surgical site free of transient
microorganisms, dirt ,oil
• Minimizes danger of infection from the skin
incision
Preliminary preparation of skin
• Mechanical
cleansing
• Hair removal
• Razor
• Degreasing
Patient’s skin prep on O.R. table
• After pt is
anesthetized
• after Foley catheter
insertion
• after positioning
Patient’s skin prep on O.R. table
• Only agents approved for
use on skin should be
used on a patient’s skin
• disposable kits
• single use applicators
• Set up
• Scrub /paint
Antiseptic solutions
• Broad-spectrum antimicrobial action /rapid
decrease of Microbial
count
• Use with ease
• Long acting
• Safe to use on skin w/o
irritation or
sensitization
• Non-toxic
• Remains effective
in the presence of
alcohol, organic
matter, soap, or
detergent
• Non-flammable for
use with laser,
ESU
Antiseptic agents:
Isopropyl Alcohol
• Advantages:
• 95% effective against
gram - and gram +
bacteria, mycobacteria,
fungi, and viruses
• available in liquid or gel
preparations
• can be combined with
other antiseptic agents
• Disadvantages:
• not completely effective
against bacterial spores
• extremely flammable
• not used on mucous
membranes, eyes, or open
wounds
Antiseptic Agents:
Chlorhexidine Gluconate (CHG)
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Advantages:
• Disadvantages:
provides residual activity • contraindicated for facial
asepsis (eyes), large open
not absorbed by skin
wounds, or burns
used for pre-op bathing as
• linked to hearing loss if
a “final wash”
used in the middle ear
• not effective in the
presence of soap, organic
debris (skin oils, blood,
body fluids)
Antiseptic agents:
Iodophor (iodine mixed with povidone) (betadine)
• Advantages:
• effective against gram-positive
bacteria
• provides residual activity
• retains microbial action in the
presence of organic debris
• available in solutions, sprays, or
gel preparations
• Disadvantages:
• iodine used alone is a major
irritant
• weak against myco-bacteria,
fungi, viruses
• absorbed into skin; may cause
toxicity
• can cause 1st/2nd degree burns
Antiseptic agents:
Triclosan
• Advantages:
• commonly found in
deodorants and soaps
• safe for ophthalmic use and
use on face
• Disadvantages:
• limited use due to short
acting effectiveness-must
repeat application
continuously to provide
effective microbial effect
Antiseptic agents:
Parachlorometaxylenol (PCMX)
• Advantages:
• non-toxic
• safe for use on eye area,
ears
• Disadvantages:
• weak against mycobacteria, fungi,
viruses
Pt risks related to surgical skin prep
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Chemical burn
Fire
Dislocation/fracture
Injury from warming
solution
• Pooling
Skin prep general guidelines
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Gather supplies prior to procedure
sterile, not clean
ALLERGY ALERT
do not use radiological detectable
surgical sponges
• do not use kick bucket as a trash can
Contaminated areas
• Umbilicus:
Contaminated areas
Stoma:
Contaminated areas
• Ulcers, sinuses,
vagina, anus:
Contaminated areas
• Foreign bodies
Contaminated areas
• Traumatic wounds:
Contaminated areas
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Areas to be grafted:
prep donor site first
use a colorless prep
use separate prep kits
Special considerations in specific anatomical areas
• Eyes
• Ears, Face,
nose
• Neck
• Chest/breast
• Shoulder
• Upper arm
• Elbow/
• forearm
• Hand
• Lateral
Thoracoabdomi
nal
• hip
• thigh
• Knee/lower leg
• ankle/foot
• Rectoperineal
• Vagina
Skin marking
• Usually done prior
to prep
• skin marker used
after prep must be
sterile
• Ethylene blue
• Alcoholic gentian
violet
Incise Drape
Documentation
• Details of preoperative skin
preparation and prep
• condition of skin and surgical site
• hair removal, method, location, areas
for attachment of monitors, time of
removal
• Antiseptic solutions, fat solvents,
irrigation solutions used
• name of person who preformed prep