Recommended practices for skin preparation of patients

AORN Journal,  Jan, 2002  

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The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommended practices for comments by members and others. They are effective Jan 1, 2002.

These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.

AORN recognizes the numerous types of settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed.

Purpose: These recommended practices provide a guideline for achieving skin preparation of the surgical site. The goal of preoperative skin preparation is to reduce the risk of postoperative surgical site infection by removing soil and transient microorganisms from the skin, reducing the resident microbial count to subpathogenic levels in a short period of time and with the least amount of tissue irritation, and inhibiting rapid rebound growth of microorganisms.

RECOMMENDED PRACTICE I

The surgical site should be assessed before skin preparation.

1. Skin should be assessed before skin preparation, and the presence of moles, warts, rashes, or other skin conditions at the surgical site should be noted and documented. Inadvertent removal of lesions traumatizes the skin at the surgical site and provides an opportunity for wound colonization by microorganisms. (1)

RECOMMENDED PRACTICE II

Whenever possible, hair should be left at the surgical site. If it is determined that hair should be removed, removal should be performed according to physicians' orders and/or according to policies and procedures in the practice setting. (2)

1. An assessment of the amount and degree of hair at the site should be performed. The necessity of hair removal depends on the amount of hair, location of the incision, and type of surgical procedure to be performed. Inappropriate hair removal techniques can traumatize skin and provide an opportunity for colonization of microorganisms at the surgical site.

2. If hair is to be removed at the surgical site, these guidelines should be followed. (3)

* Personnel skilled in hair removal techniques should perform the removal.

* Hair removal should be performed as close to the time of surgery as possible, except when a depilatory is to be used (see number four).

* Hair removal should be performed in an area outside of the room where the procedure will be performed.

* Hair removal should be performed in a manner that preserves skin integrity.

3. Microscopic exudative rashes and skin abrasions can occur during hair removal. These rashes and skin abrasions can provide a portal of entry for microorganisms. (4) When hair removal is necessary, an electric or battery-powered clipper with a disposable or reusable head that can be disinfected between patients should be used, if possible. This is the simplest and least irritating method of hair removal. (5) If hair is removed, removal should take place away from the sterile field, preferably in an area outside of the room where the procedure will be performed. The dispersal of loose hair has the potential to contaminate the surgical site and sterile field. (6)

4. Depilatories have caused skin reactions in some individuals, causing surgeries to be cancelled. (7) If a depilatory is to be used, manufacturers' written instructions regarding preapplication skin testing should be followed. Depending on the manufacturers' instructions, some depilatories may require use before the patient's arrival in the practice setting. (8)

5. Hair removal with a razor can disrupt skin integrity. If the physician orders shaving with a razor, hair and skin should be wet before shaving. Wetting hair with soapy water makes it softer and easier to remove and results in fewer microabrasions to the skin's surface. (9) Wet shaving also controls dispersal of loose hair.

6. All items used in hair removal should be disposed of or disinfected between surgical procedures.

RECOMMENDED PRACTICE III

The surgical site and surrounding areas should be clean.

1. The skin around the surgical site should be free of soil and debris. Removal of superficial soil, debris, and transient microbes before applying antiseptic agent(s) reduces the risk of wound contamination by decreasing the organic debris on the skin. (10)

2. Cleansing should be accomplished before surgical skin preparation by any of the following methods:

* patient showering and/or shampooing before arrival in the practice setting,