3-7. PERFORMING PREOPERATIVE SKIN PREP

a. After the patient is anesthetized and positioned on the operating room table, the preoperative skin prep is done by the surgeon, assistant surgeon, or circulator. This means the skin of the operative site and an extensive area round the site is mechanically cleansed again with an antiseptic solution prior to draping. A sterile skin prep tray is opened on the prep table. Usually, the prep tray is disposable, but the prep tray always contains two or more towels, small basin for solutions, sponges (these sponges must not be confused with the counted sponges on the instrument tray), and applicators.

b. Expose the skin area to be cleaned by folding back the sheet. Doublecheck the operative site and procedure against the patient's chart and operative permit.

c. Place sterile towels above and below the operative area to isolate the area and to protect gloved hands while performing the prep.

d. Don surgical gloves using the open method as follows:

(1) Make sure the glove package has not been contaminated (torn, etc.) and that the gloves are the proper size. Place the package on a clean, dry surface.

(2) Peel back the outer wrapper.

(3) Remove the inner package and place it so that the end marked "cuff" is toward you.

(4) Grasp the lower corner and open the package to a flat position.

(5) Grasp the lower corners of the package and pull to the side in order to expose the cuffs.

(6) Glove your nondominant hand first. Grasp the cuff of the glove on the same side as your nondominant hand with your dominate hand. (See Figure 3-12.)

(7) Remove the glove from the wrapper, step back, and insert your nondominant hand into the glove. (See Figure 3-13.)

(8) With the gloved hand, pick up the remaining glove with hand under the cuff and glove dominate hand.

e. Wet sponge with antiseptic solution and squeeze out excess. Using the wet sponge scrub the skin, starting at the site of incision, with a circular motion in an everwidening circle to the outer portion of the exposed area. You must use sufficient pressure and friction to remove dirt and microorganisms from skin and pores.

f. Discard the sponge after reaching the outer edge. NEVER bring a soiled sponge back toward the center of the area (Figures 3-14 and 3-15).

g. Repeat the scrub with a separate sponge for each round. Scrub for a minimum of five minutes, blot the area dry with towel, and apply the antiseptic solution in accordance with local policy (Figure 3-16). This step completes the preoperative skin prep.

h. The soiled sponges are discarded into the kick bucket. All unused sponges and those used and discarded into the kick bucket must be removed before the case (surgical procedure) begins.

Figure 3-16. Completes scrub with antiseptic solution.

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