Recommended to place a towel under the patient to catch excess fluid.
Temperature Considerations
Care should be taken with the temperature of prep solutions:
Solutions too warm can cause burns.
Warming solutions before application may be necessary for patient comfort without burning.
Contamination Considerations
Areas of higher contamination (infected wounds, stomas) must be prepped second:
Higher Level Contamination Examples: Mucous membranes and stomas, prep last.
Stoma isolation may be conducted with sterile clear adhesive strips or Betadine sponges.
Specific Cleanup Areas
Umilicus (Belly Button): Requires cleaning first to prevent contamination from going onto the prepped area.
Open Wounds: Must be irrigated with warm sterile water or saline and packed with sterile gauze during the prep.
Role of Separate Preps
Donor and recipient sites require separate skin preparations:
Donor Site Prep: Typically uses a colorless solution (CHG) for visibility during graft harvest.
Recipient Site Prep: Often prepped last due to being more contaminated (open wounds).
Abdominal, Perineal, and Vaginal Procedure Prep
Vaginal and perineal areas prepped first to avoid contamination of the abdominal area.
Prep Technique
Prepping technique typically involves:
Starting at the planned incision site and moving outward in a circular motion.
Circumferential Prep: Necessary for limbs or areas needing goes around in a complete circle.
Importance of Adhering to Guidelines
Following manufacturer's guidelines regarding antiseptic exposure time is crucial to prevent skin marking removal.
Equipment and Setup
Items for skin prep should be organized on a sterile Mayo stand or prep stand for easy access during surgeries.
Two-Step vs. One-Step Prep
Two-Step Prep: Involves a soap-based scrub of the surgical site followed by a residual antiseptic coating, often referred to as scrub and paint technique.
One-Step Prep: Uses a commercial single-use applicator containing alcohol-based antiseptic, requires only one application, drying time is three minutes to reduce fire risk.
Safety Concerns
Avoid igniting alcohol-based solutions during use; they are contraindicated near the eyes, ears, mouth, and face.
Specific ophthalmic solutions are required for areas around the eyes to ensure patient safety.
Guidelines for Specific Regions
Abdominal Prep: Extends from the nipple line to the pubis, possibly covering the thighs for low abdominal incisions.
Chest and Breast Prep: Involves upper arm elevation and includes shoulder, axilla, and chest.
Extremity Prep: The extremity must be elevated for complete circumferential cleaning.
Perineal Prep: Must always proceed front to back on females, and separate prep kits are needed for combined operations.
Assessment and Training
Observational assessments where one person watches the prep being done to ensure all spots are covered and techniques are properly followed.
Risks and Considerations
Acknowledgment of missed spots during the prep; if missed, need to restart with a fresh applicator instead of touching previously treated areas.
The expectation of assistance needed for patients with higher BMI or difficult positioning during prep.
Equipment Assistance
Equipment like a hover mat may be utilized for high BMI patients to facilitate transfers and positioning during procedures.