Archive January 2017 XVIII, No. 1

Surgical Skin Antisepsis Done Right

10 tips for ensuring that patients begin their surgical procedure with an aseptic surgical site.

Dan O

Dan O'Connor, Editor-in-Chief


basis for preventing surgical site infections SCRUB AND PAINT The fundamental basis for preventing surgical site infections is the antiseptic preparation of the skin at the surgical site.

So devoted was a spine surgeon to his skin prep that he was moved to say: "You can cheat on your spouse, but you can't cheat on your 6-minute prep." Don't misunderstand. He brought up infidelity only to show how faithful he was to his prep.

"He was very particular," says Margaret Sherman, RN, BSN, clinical director of the Hamilton (N.J.) Endoscopy & Surgery Center. "Six minutes of scrubbing and prepping: That's how he was taught."

Couple that with the surgeon's superstitious streak and the fact that he'd never had an infection with his 6-minute prep and, yes, you guessed it, that spine surgery was wed to his prep.

"Every surgeon has his preference and it rarely changes," says Ms. Sherman. "It's a waste of time, effort and money to try."

Skin prepping is hardly complex, but it is by no means a simple process. There's a right way — and there are many wrong ways — to safely prepare your patient's skin. As Sheila Tesiny, RN, CNOR, the clinical coordinator of outpatient surgery at Henry Mayo Newhall Hospital in Valencia Calif., says, "The prep is the start to a successful case. Never underestimate the importance of it." As you'll see in these 10 tips, there's more to safe prepping than starting at the incision site and spiraling outward.

1. Don't assume your nurses know the proper application technique. Review prep manufacturers' directions and compare them to what's actually being performed in the ORs. If necessary, conduct in-service training to ensure consistent technique in all cases. "You'd be surprised at how many variations people put into their own practices," says Jesse Hixson, MSN, RN, CNOR, an OR manager at West Virginia University Health Care. "If someone has bad technique, they're bringing a breach in sterility to the surgical table."

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