Common Prepping Patterns

University:
The University Of Western Ontario
Course:
Pathology 3500B | Human Pathology
Academic year:

2023
Views:

66

Pages:

3
Author:

Kyuwon J.

● Prepping patterns ○ Surgical skin prep used to reduce risk in SSI (surgical site infection) ○ Removal of dirts and oils ○ Does not sterilizes skin - skin cannot be sterilized ■ But will reduce in bacterial counts ○ Prep from clean to dirty ● Prepping Patterns ○ Incision site from outwards ■ Clean to dirty ■ Start at intended incision sites = cleanest ■ Never bring the applicator inward ● Will contaminate it again ○ used for surgeries in clean fields ■ hernia repair ■ vascular access ● Surgical yields towards dirty area ○ field => dirty ○ used once operative fields has contaminated zones ■ Perineum = high bacterial load ■ Rectum and Anus ■ Colostomy ■ Ileostomy sites = stomas could be source of contaminations ■ Umbilicus = deep skin folds could be packed with dead skin debris, and bacteria. ● ● ● ● ● ○ Cleanest part is prepped first then dirty area is prepped next Surgical prep ○ broad stroke + concentric circles ■ no overlapping ■ no back inward movements ○ Clean => dirty ○ Must cover wide area ■ beyond drape fields Skin Prep ○ Hair removal ■ only if necessary ■ use clippers instead of razors. This is to avoid risk of microabrasions ■ done prior to surgery ○ Prep area size ■ Prepping wider are beyond the fields ■ Possible extension of incision ● New port sites possible Application techniques ○ Long strokes or concentric circles ○ Retracing shall not be done at all times ○ Larger area ■ Prep in overlapping zones ■ Progression outwards Drying time ○ Need to give time for solution to be fully dried out ■ 2-3 min needed for alcohol-based agents ○ Prevention in chemical irritation ○ Fire hazard must be looked out ○ Electrocautery Contaminated sites ○ Special types of prep is needed for umbilicus ○ Stroma ■ Occlusive dressing needed after prepping outwards Antiseptic solutions Agent Spectrum Onset Residual Effect Advantage s Disadvantages Chlorhexidine (CHG) Broad (G+, G−, fungi, enveloped viruses) Rapid Persistent (up to 6 hrs) Excellent residual, low skin irritation Not effective vs spores; ototoxic/neurotoxic if introduced in ear or meninges Povidone-Iodin e (Betadine) Broad (G+, G−, fungi, viruses, some spores) Intermediate Minimal Widely available, cheap Inactivated by blood/organic matter; slower onset; rare iodine allergy Alcohol (70%) Broad (G+, G−, fungi, viruses) Immediate None Fast, potent bactericidal Flammable; drying; no residual activity Combination (e.g., CHG + Alcohol, Iodine + Alcohol) Broadest Rapid Depends on base agent Superior SSI reduction Flammability, must dry completely before cautery