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Patient Skin Antisepsis


Why do we remove cosmetics before the preoperative skin prep?

Answer:

Cosmetics may contribute to increased soil and contamination and impede the effectiveness of the antiseptic agent. The removal of facial cosmetics also may be indicated to prevent debris from irritating the eyes, to facilitate securing the endotracheal tube, or for other reasons identified by the surgical team.

Resource

  • Recommended practices for preoperative patient skin antisepsis. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:75-90

Updated January 28, 2013 

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What precautions should providers take when removing hair at the surgical site?

Answer:

If the presence of hair will interfere with the surgical procedure and removal is in the best interest of the patient, the provider should take the following precautions:

  • Hair removal should be performed the day of the surgery, in a location outside the operating or procedure room.
  • Only hair interfering with the surgical procedure should be removed.
  • Hair should be clipped using a single-use electric or battery-operated clipper, or clipper with a reusable head that can be disinfected between patients.

Resource

  • Recommended practices for preoperative patient skin antisepsis. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:75-90.

Updated January 28, 2013 

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How can I minimize the fire risk when using flammable patient skin antiseptic products?

Answer:

Because the potential for a fire exists in the presence of the triad of oxygen; energy sources (eg, electrosurgical units, lasers, light cords); and alcohol, it is critical that perioperative personnel receive education on the flammability of certain antiseptic products. In addition, the following interventions relating to the use of prep antiseptic products can minimize the fire risk in the OR:

  • Allow sufficient drying time, including time for the vapors to dissipate, before applying surgical drapes, using an active electrode or laser, or activating a fiber-optic light cable.
  • Use the smallest amount possible within the amount described in the manufacturer's written directions, for a single application to help avoid pooling by the product on or under body parts.
  • Protect sheets, padding, positioning equipment, etc. from dripping or pooling of prep agents and remove wet items after prep.
  • Include the fire risk assessment in the "time-out" period.

Resources

  • Recommended practices for preoperative patient skin antisepsis. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:75-90.
  • Recommended practices for a safe environment of care. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013;217-242.
  • AORN Fire Safety Tool Kit. AORN, Inc. http://www.aorn.org/PracticeResources/ToolKits/FireSafetyToolKit. Accessed June 24, 2011.

Updated January 28, 2013 

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Which patient skin antiseptic products are flammable?

Answer:

Alcohol, some chlorhexidine gluconate (CHG) with alcohol, and some iodine-based agents with alcohol are rated as flammable patient antiseptic products. It is important to note, however, that chlorhexidine gluconate and providone-iodine without alcohol are not flammable but may be combustible. The National Fire Protection Association (NFPA) defines flammable as having a flash point below 100 degrees Fahrenheit. Those products with a flash point above 100°F are considered to be combustible. The flash point for all manufactured products can be found on the SDS sheets.

Resources

  • Recommended practices for preoperative patient skin antisepsis. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:75-90.
  • Recommended practices for a safe environment of care. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013;217-242.
  • National Fire Protection Association. NFPA 30: Flammable and Combustable Liquids Code. 2008 ed. Quincy, MA: National Fire Protection Association; 2008.
  • AORN Fire Safety Tool Kit. AORN, Inc. http://www.aorn.org/PracticeResources/ToolKits/FireSafetyToolKit. Accessed June 24, 2011.
  • Surgical fire prevention. ERCI Institute. https://www.ecri.org/Products/Pages/Surgical_Fires.aspx. Accessed June 24, 2010.

Updated January 28, 2013 

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For a procedure that involves the genitalia, should a urinary catheter be inserted before or after the surgical skin prep?

Answer:

When the surgical area involves the genitalia and the patient requires a urinary catheter, the nurse should insert the catheter after performing the surgical skin prep.

Resource

  • Burlingame, BB. Perineal preps and urinary catheter insertion. [Clinical Issues]. AORN Journal. 2011;94(1):100.

Updated January 28, 2013 

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