{"id":31,"date":"2015-12-03T17:44:21","date_gmt":"2015-12-03T17:44:21","guid":{"rendered":"http:\/\/brooksidepress.org\/surgery\/?page_id=31"},"modified":"2023-08-20T20:40:11","modified_gmt":"2023-08-20T20:40:11","slug":"1-02-preparation-of-the-operative-site","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/surgery\/?page_id=31","title":{"rendered":"1-02. PREPARATION OF THE OPERATIVE SITE"},"content":{"rendered":"

a. The “Skin-Prep.”<\/strong> Preparation of the operative site is more commonly known\u00a0as “skin-prep.”<\/p>\n

The purpose of preparing the site is to render that area as free as\u00a0possible from transient and resident microorganisms, dirt, and skin oil. All or any of\u00a0these could infect an open wound. The goal of this preparation is to allow the surgical\u00a0procedure to be performed with a minimal danger of infection.<\/p>\n

b. Basic Prep: Initial Procedures<\/strong>. The basic preparatory procedures at the\u00a0site are as follow.<\/p>\n

(1) Expose the skin to be prepared.<\/p>\n

(2) Don sterile gloves.<\/p>\n

(3) Place sterile towels above and below the area to be cleaned.<\/p>\n

(4) Place sterile, absorbent towels along each side of the area. These\u00a0towels act as an absorber for any solution that has run off. Remove these towels after\u00a0the site preparation is completed.<\/p>\n

c. Basic Prep: Skin Scrub Procedures<\/strong>. Scrub the skin in this manner:<\/p>\n

(1) Wet a sponge with antiseptic solution (or use a prepackaged scrub\u00a0brush). Squeeze out the excess solution to prevent run off of fluid.<\/p>\n

(2) Starting at the intended site of incision, scrub the skin using circular\u00a0motions in ever-widening circles. Scrub for at least ten minutes. Use enough pressure\u00a0and friction to remove dirt and microorganisms. Remember it takes both chemical\u00a0(contact time) and mechanical (scrubbing) action to cleanse the area.<\/p>\n

(3) Discard the sponge after you reach the outside of the area.<\/p>\n

(4) Repeat this scrubbing procedure with a clean sponge.<\/p>\n

(5) Scrub the incision site for a minimum of ten minutes.<\/p>\n

CAUTION: Never bring a soiled sponge back toward the center of an area.<\/strong><\/em><\/p>\n

d. Preparation of Traumatic Wounds: Procedures<\/strong>. A traumatic wound is any\u00a0wound that occurs as a result of injury or other damage. The wound is considered\u00a0contaminated.<\/p>\n

(1) Procedures. A variety of procedures may be needed in preparing a\u00a0traumatic wound for incision. The wound may need to be irrigated or the wound may\u00a0require packing or covering with sterile gauze.<\/p>\n

(2) Type of procedure. The wound can be cleansed and irrigated after you\u00a0change to sterile gloves. The extent and type of injury will determine what preparatory\u00a0procedure you choose.<\/p>\n

e. Preparation of Traumatic Wounds: General Guidelines<\/strong>. Note these\u00a0guidelines:<\/p>\n

(1) Do not use solutions such as detergents and alcohols that can irritate an\u00a0area in which tissue has been lost.<\/p>\n

(2) You may irrigate small areas with a warm sterile solution, usually normal\u00a0saline, in a bulb syringe.<\/p>\n

(3) The purpose of irrigating a wound is to flush out debris gently.<\/p>\n

(4) When flushing out a large wound, you may need to use copious\u00a0amounts of a warm saline solution.<\/p>\n

(5) A bottle of warm saline or Ringer’s solution attached to IV tubing may be\u00a0used to irrigate a wound.<\/p>\n

(6) Following irrigation, a wound is usually debrided.<\/p>\n

f. Hair Removal<\/strong>. Remove hair carefully to avoid injuring the skin.<\/p>\n

A break in\u00a0the skin, even though caused by only hair removal, can provide an opportunity for entry\u00a0and colonization of microorganisms with the potential for infection. Shaving an area\u00a0should be done as close to the time of the incision as possible. The longer the time\u00a0between the shaving and the incision, the greater is the chance of infection.<\/p>\n

CAUTION: NEVER shave or clip eyebrows.<\/strong><\/em><\/p>\n

g. Irrigation.<\/strong> The irrigation fluid of choice is normal saline since this fluid is\u00a0nonirritating to body tissue.<\/p>\n

(1) Efficiency of irrigation. Efficient irrigation is achieved at 7 to 9 pounds\u00a0per square inch (psi). This is not easy to gauge when conducting irrigation in the field.\u00a0It is commonly agreed that to achieve optimal irrigation pressure without excessive\u00a0pressure you should use an 18-gauge (ga) needle on the end of a syringe or\u00a0intravenous (IV) tubing.<\/p>\n

(2) Methods of irrigation. There are three commonly used methods of\u00a0irrigating wounds: by bulb or asepto syringe, by 35cc syringe and a 18-gauge needle,\u00a0and by a mechanical jet device. Irrigation using a 35cc syringe and an 18-gauge needle\u00a0is the preferred method for irrigating contaminated wounds and uses intermediate\u00a0pressure. Normal saline is the solution of choice, but any potable water can be used.\u00a0Mechanical jet and pulse irrigation should not be used because they tend to push debris\u00a0deeper in to the wound rather than out of the wound, thus causing more damage and\u00a0increasing the risk of infection.<\/p>\n","protected":false},"excerpt":{"rendered":"

a. The “Skin-Prep.” Preparation of the operative site is more commonly known\u00a0as “skin-prep.” The purpose of preparing the site is to render that area as free as\u00a0possible from transient and resident microorganisms, dirt, and skin oil. All or any of\u00a0these could infect an open wound. The goal of this preparation is to allow the surgical\u00a0procedure … Continue reading 1-02. PREPARATION OF THE OPERATIVE SITE<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":26,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-31","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/31","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=31"}],"version-history":[{"count":3,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/31\/revisions"}],"predecessor-version":[{"id":343,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/31\/revisions\/343"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/26"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}