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6 Dos and Don'ts of Skin Prep

Publish Date: 8/21/2013

The origin of many surgical site infections is a patient's own skin, notes Amber Wood, MSN, RN, CNOR, CIC, CPN, perioperative nursing specialist for AORN. It is therefore critical for perioperative professionals to perform proper skin prep and reduce the organisms that live on a patient's skin as much as possible before the integrity of the skin is broken for surgery.

"When the skin is broken for a procedure to begin, we are providing a portal for organisms and bacteria to enter into places in patients' bodies that previously weren't exposed when they had intact skin," she says.

Wood identifies six dos and don’ts of proper patient skin prep.

Do: Follow manufacturers' instructions for use. Skin prep agents are regulated by the U.S. Food and Drug Administration, so they have very detailed instructions on how to properly use them. "One of the most common mistakes we see is people just not following those instructions correctly and completely," Wood says. Included in the instructions is the amount of prep to use, how much of the skin surface the prep should cover and time required for the prep to dry.

Two common don’ts associated with following these instructions are:

  • Don't put the prep on too thin. "If you put the prep on too thin, it might not stay as wet as long it needs to," Wood says. "It may not be killing all the organisms it needs to kill if it doesn't have enough contact time."
  • Don't put the prep on too thick. Too much prep makes it more difficult to dry. "That's a fire hazard because a lot these agents are flammable," Wood says. "If it's not dried then we have a risk of a fire developing."

Do: Check prep labels periodically. The labels on the surgical skin prep bottles — which include the instructions — can change, so it is important to have a system that ensures they are periodically checked.

"Once someone gets comfortable using a product, it's easy to forget to check the label to make sure there are no changes in dry times or other requirements," Wood says. "Organizations will typically assign a point person who is in charge of periodically checking those instructions for use. In addition, since skin prep is an FDA-regulated product, the manufacturers should issue notifications of any changes, and this point person will keep an eye out for such announcements."

Guidelines for Perioperative Practice


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