Chiamaka Emelife

ISM 1st Period

Hemani, Micah L., and Herbert Lepor. "Skin Preparation for the Prevention of Surgical Site

Infection: Which Agent Is Best?" Reviews in Urology. MedReviews, LLC, 2009. Web.

30 Mar. 2017.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809986/

The most common skin preparation agents used today are products that contain
iodophors or chlorhexidine gluconate
Agents are classified by whether they are aqueous-based or alcohol-based
solutions
Aqueous-based iodophors, such as povidone-iodine, are one of the few products
that can be safely used on mucous membrane surfaces
Alcohol-based solutions are quick, sustained, and durable
Alcohol-based solutions are used for longer open surgeries
The choice of agent should be based primarily on the surgeons knowledge of the
products efficacy, cost, and ease of use
The first use of an antiseptic skin agent in surgery is credited to the English
surgeon Joseph Lister
Before the mid-19th century, limb amputation was associated with an alarming
50% postoperative mortality from sepsis
Louis Pasteurs discovered that tissue decay was caused by microscopic
organisms
The spread of these microbes through surgical wounds caused death in the
postoperative period
Alcohol-based solutions may have greater efficacy, easier application, improved
durability, and a superior cost profile when compared with traditional aqueous-
based solutions
Ethyl and isopropyl alcohol are 2 of the most effective antiseptic agents available
Alcohol alone is fast and short acting, has broad-spectrum antimicrobial activity
DuraPrep solution, an antiseptic skin solution shows durability in the
surgical/procedural environment and enhances adhesion between surgical drapes
and the prepared skin surface, limiting the spread of organisms onto the surgical
field

This article was helpful because I was able to learn and read about the most important
antiseptics to prevent the cause of infections in surgery and why certain ones are used
for certain surgeries.
 Chiamaka Emelife
ISM 1st Period

Ukay, Ilker, and Stephan Harbarth. "Preventing Surgical Site Infections." Medscape. N.p., n.d.

Web. 30 Mar. 2017.

http://www.medscape.com/viewarticle/723601

SSI - Surgical Site Infection

SSIs is an infection related to surgical procedure, occurs typiclally 30 days after
or less than 90 days after surgery
SSIs are very common
31% all hospitals-acquired infections are high because of the numbers of
procedures have increased
More antimicrobial-resistant pathogens are emerging
SSIs are exposed because sicker patients are having surgery
Patients with SSI tend to stay 7-11 days longer in the hospital
60% of patients with SSI are likely to go to the ICU and 30 day readmission for
surgery
Hand preparation is the most important SSI prevention strategy
Prophylactic antibiotic use depends on a number of key principles: the patient's
individual history of allergy must be considered
Preoperative bating or showering can help prevent SSI
Skin preparation is very important
Even with optimal preparation, true sterilization of the skin is impossible
For several decades, povidone-iodine or chlorhexidine have been generally used
for skin antisepsis
Sterile gloves and adhesive drapes are always used in the operating room
Gloves are used to prevent site contamination, but also reduce blood-borne
pathogen transmission from patients to surgeons
If hair removal is performed, this should be carried out with clippers and not
razors immediately before surgery and not the previous evening
Hands must be cleaned before and after wound care
Hair removal prevents bacteria from being trapped in hair follicles which could
enter into the skin

There are many ways to contain surgical site infections but they cant be avoided,
such as hair removal, bathing/showering and skin prep, there are also many things
that can cause a SSI and why the rate of SSIs are growing.
 Chiamaka Emelife
ISM 1st Period

C. "AST Standards of Practice for Skin Prep of the Surgical Patient." AST Standards of Practice

for Skin Prep of the Surgical Patient Introduction (n.d.): n. pag.

http://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/Standard_Skin_Prep.pdf

The surgeon orders may include the patient taking a bath or showering with an
antiseptic agent the night before surgery and/or the morning of surgery.
The preoperative patient interview should include asking the patient if she/he has
any known allergies, as well as a review of the patients history
If the patient has an allergy to shellfish, which iodine is contained of, a non-iodine
prep solution must be used.
If the patient has allergies to strawberries, bananas, kiwis, or poinsettias, which
contain elements of latex, the nurse and surgeons must use non-latex gloves.
If the patient indicates an allergy or allergies to particular antimicrobial solution,
this should be indicated in the patient chart, on the cover of the patient chart, and
on the patient allergy wrist band to be worn on the day of surgery
The surgical team should refer to the surgeons orders pertaining to hair removal
If the shave prep is ordered, it should be performed as close to the time of surgery
as possible in order to reduce the risk for microbial growth in breaks in the skin.
The shave prep should not be performed in the OR The shave prep should be
performed in the preoperative holding area where the privacy of the patient can be
maintained
It is recommended that an electric clipper be used for hair removal
The hair that is removed must be placed in a secure container or bag or properly
disposed of, preferably ziplock-type bag that is labeled with the patients name
Alcohol is an accepted antiseptic agent; however, it should not be used as the
single agent but as part of the skin prep regimen
The surgical team member performing the skin prep should first perform a hand
wash
The skin prep last a minimum of five minutes, and until all sponges have been
used
The boundaries of the skin prep should be much wider than the planned incision
site in order to reduce the risk of SSI
The paint solution should be applied with prep stick sponges
Alcohol and alcohol-based agents should not be used on mucous membranes

This article was very beneficial because it mentions the most highly important steps
about prepping the patients skin for surgery, such as proper hair removal steps and
skin prepping facts with alcohol and saline instructions.
 Chiamaka Emelife
ISM 1st Period

Prinsen, Kimberly. "Surgical Skin Prep - Perioperative Patient Care Fundamentals." Infection

Prevention News. N.p., 10 May 2016. Web. 30 Mar. 2017.

http://infection-prevention-news.3m.com/surgical-skin-prep-perioperative-patient-

care-fundamentals/

Check for patient allergies or sensitivities to the ingredients contained in the

surgical skin preparation products
Certain skin preps are not recommended for patients under two months of age due
to the risk of excessive skin irritation or absorption of the active ingredient
If the surgical site is near the eyes: alcohol-based preps would not be appropriate
nor would chlorhexidine gluconate (CHG) products due to the risk of corneal
damage
If the surgical site is near the ears: alcohol-based preps would not be appropriate
nor would CHG products due to the risk of ototoxicity/potential deafness
If prep includes mucous membranes: no alcohol-based products should be used
If the skin is not intact: alcohol-based preps should not be used
If the procedure involves large amounts of fluid select a prep that is resistant to
being washed off when challenged with irrigation solution, blood or sponges that
come in contact with the prepped skin
If a drape will be used in the surgery, select a prep that enhances drape adhesion
so that once you create that sterile field with an incise drape there is a reduced
incidence of drape lift
The minimum dry time for a prep containing alcohol is 3 minutes on hairless skin
and up to an hour in hair
Following dry time ensures prep efficacy, patient safety and minimizes skin
irritation
If the prep site is dry (e.g. back, abdomen, leg) the estimated application time will
be 30 seconds
If the prep site is considered a moist site (e.g. axilla, groin) the antiseptic needs to
be applied to the skin for 2 minutes
Solutions that combine alcohol and another active ingredient (e.g. iodine
povacrylex or CHG) kill bacteria more quickly and have shorter application times
than those that do not contain alcohol
Application methods range from being painted on, scrubbed on, or applied in
gentle back- and- forth strokes

There are many routines that need to be followed up on when it comes to proper
surgery site prepping, such as selecting the right prep to use depending on the site.