a. The “Skin-Prep.” Preparation of the operative site is more commonly known as “skin-prep.”

The purpose of preparing the site is to render that area as free as possible from transient and resident microorganisms, dirt, and skin oil. All or any of these could infect an open wound. The goal of this preparation is to allow the surgical procedure to be performed with a minimal danger of infection.

b. Basic Prep: Initial Procedures. The basic preparatory procedures at the site are as follow.

(1) Expose the skin to be prepared.

(2) Don sterile gloves.

(3) Place sterile towels above and below the area to be cleaned.

(4) Place sterile, absorbent towels along each side of the area. These towels act as an absorber for any solution that has run off. Remove these towels after the site preparation is completed.

c. Basic Prep: Skin Scrub Procedures. Scrub the skin in this manner:

(1) Wet a sponge with antiseptic solution (or use a prepackaged scrub brush). Squeeze out the excess solution to prevent run off of fluid.

(2) Starting at the intended site of incision, scrub the skin using circular motions in ever-widening circles. Scrub for at least ten minutes. Use enough pressure and friction to remove dirt and microorganisms. Remember it takes both chemical (contact time) and mechanical (scrubbing) action to cleanse the area.

(3) Discard the sponge after you reach the outside of the area.

(4) Repeat this scrubbing procedure with a clean sponge.

(5) Scrub the incision site for a minimum of ten minutes.

CAUTION: Never bring a soiled sponge back toward the center of an area.

d. Preparation of Traumatic Wounds: Procedures. A traumatic wound is any wound that occurs as a result of injury or other damage. The wound is considered contaminated.

(1) Procedures. A variety of procedures may be needed in preparing a traumatic wound for incision. The wound may need to be irrigated or the wound may require packing or covering with sterile gauze.

(2) Type of procedure. The wound can be cleansed and irrigated after you change to sterile gloves. The extent and type of injury will determine what preparatory procedure you choose.

e. Preparation of Traumatic Wounds: General Guidelines. Note these guidelines:

(1) Do not use solutions such as detergents and alcohols that can irritate an area in which tissue has been lost.

(2) You may irrigate small areas with a warm sterile solution, usually normal saline, in a bulb syringe.

(3) The purpose of irrigating a wound is to flush out debris gently.

(4) When flushing out a large wound, you may need to use copious amounts of a warm saline solution.

(5) A bottle of warm saline or Ringer’s solution attached to IV tubing may be used to irrigate a wound.

(6) Following irrigation, a wound is usually debrided.

f. Hair Removal. Remove hair carefully to avoid injuring the skin.

A break in the skin, even though caused by only hair removal, can provide an opportunity for entry and colonization of microorganisms with the potential for infection. Shaving an area should be done as close to the time of the incision as possible. The longer the time between the shaving and the incision, the greater is the chance of infection.

CAUTION: NEVER shave or clip eyebrows.

g. Irrigation. The irrigation fluid of choice is normal saline since this fluid is nonirritating to body tissue.

(1) Efficiency of irrigation. Efficient irrigation is achieved at 7 to 9 pounds per square inch (psi). This is not easy to gauge when conducting irrigation in the field. It is commonly agreed that to achieve optimal irrigation pressure without excessive pressure you should use an 18-gauge (ga) needle on the end of a syringe or intravenous (IV) tubing.

(2) Methods of irrigation. There are three commonly used methods of irrigating wounds: by bulb or asepto syringe, by 35cc syringe and a 18-gauge needle, and by a mechanical jet device. Irrigation using a 35cc syringe and an 18-gauge needle is the preferred method for irrigating contaminated wounds and uses intermediate pressure. Normal saline is the solution of choice, but any potable water can be used. Mechanical jet and pulse irrigation should not be used because they tend to push debris deeper in to the wound rather than out of the wound, thus causing more damage and increasing the risk of infection.