The LSUHSC New Orleans
Emergency Medicine Interest Group
The Student Procedure Manual
Preoperative Skin Preparation of Patients
Purposes and Principles
- These recommended practices provide a guideline for the preoperative skin
preparation of the operative site. The goal of the preoperative skin preparation
is to reduce the risk of postoperative wound infection by:
- removing soil and transient microbes from the skin
- reducing the resident microbial count to subpathogenic amounts in a short
period of time and with the least amount of tissue irritation, and inhibiting
rapid rebound growth of microbes.
- The area surrounding the operative site should be clean.
- Cleansing can be accomplished before surgery by:
- Patient shower(s)
- Washing the operative site on the patient unit, and/or
- Washing the operative site immediately before applying the antimicrobial
agent in the OR.
- The operative site should be assessed before skin cleansing. Skin integrity
and allergies affect the choice of a cleansing agent. Traumatized, denuded,
and/or burned skin may require saline irrigation as the cleansing agent.
- Hair should remain at the operative site unless it is so thick that it interferes
with the surgical procedure (eg, craniotomy).
- If hair removal is requested, it should be performed in a patient care area
that affords privacy and good lighting, and it should be done by a person
who has demonstrated skill in the procedure.
- Three possible methods for the removal of hair from
the skin around the operative site are as follows:
- a depilatory.
- an electric clipper with a disposable or removable head that can be sterilized
between patients, and
- a sharp, well-designed disposable or terminally sterilized razor.
- Shaving should be done as close to the time of the operative procedure as
- The wet method of shaving is desirable.
- Persons performing the shave prep should wear protective gloves.
- If shaving is performed more than a few hours before surgery, even microscopic
abrasions provide a good culture medium for microorganism with subsequent
risk of wound infection.
- The skin of the operative site and surrounding area should be prepared with
an antimicrobial agent(s) before the incision.
- Patient sensitivity, anatomy, and the condition of the skin at the operative
site influence the choice of agent(s).
- The area of prep should be wiped, and sterile equipment should be used. A
person who has demonstrated skill in the procedure should use a prescribed
technique taking into consideration the following:
- condition of the skin at the incision site.
- presence of areas of high bioburden within the
- presence of mucous membrane, bowel, and/or denuded tissue.
- anatomy involved.
- proposed surgical procedure, and
- size of drape fenestration.
- The agent(s) should be applied in a manner that prohibits pooling beneath
the patient, tourniquet, electrodes, or electrosurgical dispersive pad.
- If electrosurgery is to be used, sufficient time should elapse between the
skin preparation and application of drapes to permit complete evaporation
of any flammable substance, such as alcohol or fat solvents.
This page copyright © 1997-2002 LSUHSC EMIG. All rights reserved.