Archive Infection Control 2017

Make No Mistake: Prepping the Skin Takes Time

How to convince your surgeons and staff that a proper skin prep can't be rushed.

Teresa Glandorf, BSN, RN, CNOR

periphery with your prep NO TURNING BACK Once you've moved to the periphery with your prep, you don't want to go back to the incision site.

To a surgeon, 30 or so seconds it takes to apply a skin prep can seem like a long time. The 3 minutes he must wait for the prep to dry before you can drape the patient? That must feel like an eternity. The surgeon understands that prepping must occur, but also likes to be time efficient, and may at times ask the OR team to drape earlier than the needed 3-minute wait time.

Of course, we all know that prepping the skin with an antiseptic agent before the first incision is an indispensable step in preventing surgical site infections. We also know it takes time. But the 30-second, back-and-forth friction scrub at the incision site is time well spent (plus, the longer you prep, the better you're able to reach the deeper skin layers). And waiting 3 minutes for an alcohol-based prep to dry before you drape not only helps prevent surgical fires, especially during electrosurgical cases. Equally important is that it is the amount of time that is required to reduce the bacterial load on the skin.

But there's more to prepping the skin than just taking your time. Technique is important, too. For example, you start a chlorhexidine gluconate scrub at the incision site and work your way out in concentric circles. Once you've moved to the periphery, you don't want to reverse your clean-to-dirty course and go back to the incision site, possibly spreading contaminants. Another tactical consideration: How many prepping sticks do you need to cover the body part you're prepping? You want neither too little (insufficient coverage) nor too much (pooling).

In late 2015, our frontline staff reported to us that we didn't always prep the site according to the prep manufacturer's recommendation. (The fact that our nurses were concerned enough to bring this to our attention is a testament to their commitment to safe patient care.) We also observed more and more breaches in proper prepping technique in our 8 ORs. Here's how we shored up the weaknesses in our prepping process.

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