Surgical skin asepsis is like many areas of medicine: fraught with misconceptions that are often in error but seldom in doubt. Want to start a great debate? Ask your surgeons and nurses to defend their skin prepping preferences and beliefs. Should you wear a long-sleeved jacket when you apply a prep? Which antiseptic should you use for vaginal antisepsis? Here are 10 questions to get the discussion going, followed by their AORN-approved answers.
1. Is it necessary to wear a long-sleeved jacket when performing patient skin antisepsis?
Yes. We get this question a lot. Some of us were taught that we should remove our jacket before applying a prep. The thinking was that the sleeve could contaminate the area you're prepping. But if the RN circulator performs the pre-operative skin antisepsis without wearing a long-sleeved jacket, skin squames from her bare arms may drop onto the area that is being prepped and may increase the patient's risk for a surgical site infection. The recommendation for nonscrubbed personnel to wear long-sleeved jackets in the OR or invasive procedure room is not a new recommendation. It has been a part of the AORN "Recommended Practices for Surgical Attire" since 1994. Wearing long-sleeved attire helps contain skin squames shed from bare arms.
2. Should I remove a patient's nail polish or artificial nails before prepping her?
Yes, if the patient is having hand or foot surgery. Nails on the operative extremity should be clean and natural without artificial nail surfaces or polish. The evidence review for AORN's new recommended practices document (Recommended practices for preoperative patient skin antisepsis. [In Press] In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014. [IVA]) found no cases of patient incision-site contamination related to wearing artificial nails or nail polish on the operative hand and foot. In 2 separate studies, researchers found that the amount of potentially pathogenic bacteria cultured from the fingertips of healthcare personnel wearing artificial nails was greater than for those with natural nails, both before and after hand washing. Artificial nail surfaces or polish may harbor microorganisms, which could contaminate the surgical site or reduce the effectiveness of pre-operative patient skin antisepsis. This is the first time AORN has taken a position on patients' wearing artificial nails. Essentially, we're prescribing the same fingernail precautions for patients having hand or foot surgery as we do for healthcare workers. If a patient's having abdominal surgery, it's OK for her to wear artificial nails or nail polish if permitted by facility policy.