You might think you know all you need to about skin prep, but are you sure you're up to date with the latest best practices? Properly prepping the skin should be a top priority for your facility, especially since it's an easy-to-implement infection prevention effort that's relatively affordable. Quiz yourself and your staff with the skin prep pop quiz below.

1. Which surgical skin prep is accepted as the most effective?

• a. povidone-iodine
• b. chlorhexidine gluconate
• c. none of the above
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  • c. none of the above. The battle rages on over which skin prep is clinically considered the best. The leading infection prevention authorities, including the Association of periOperative Registered Nurses (AORN), don't recommend using either chlorhexidine gluconate (CHG) or povidone-iodine for all of your cases.

    However, in its updated Guideline for Prevention of Surgical Site Infection, released in 2017 (osmag.net/9okZGA), the Centers for Disease Control and Prevention (CDC) notes that "skin preparation in the operating room should be performed using an alcohol-based agent, unless contraindicated." In its recommendations for preventing surgical site infections, the World Health Organization (WHO) also recommends using "alcohol-based antiseptic solutions based on CHG for surgical site skin preparation in patients undergoing surgical procedures," noting that moderate quality evidence supports the recommendation of using alcohol-based antiseptic solutions compared with aqueous solutions.
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2. True or false: You should avoid clipping a patient's hair before surgery, but if clipping is needed, then it should take place in the OR.

• a. True
• b. False
• Reveal

  • b. False. Both the CDC's and AORN's evidence-based practice guidelines recommend that staff not remove a patient's hair before surgery unless it will impede the procedure. Removing hair could be associated with an increase in surgical site infections because when the hair is removed, there is potential for trauma to the skin.

    If you absolutely need to remove hair before surgery, then AORN says it should be done outside the OR and that you should use a clipper or depilatory. Make sure to also instruct patients not to shave pre-operatively at home. Finally, AORN notes that when removing hair, it should be done in a way that prevents its dispersal, either by wet clipping or using a clipper that has a suction function to catch the loose hair.
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3. True or false: Skin preps should always be applied in a circular motion, from clean to dirty areas.

• a. True
• b. False
• Reveal

  • b. False. Don't automatically assume that all preps require the circular motion that used to be the standard. Instead, AORN recommends reading the manufacturer's directions for use. Generally, CHG formulations require a back-and-forth scrubbing motion over the site, starting with the least contaminated area and moving to the most contaminated areas. For povidone-iodine solutions, you typically want to use a circular application, again moving from clean to dirty areas. Regardless of technique, apply the prep in an area that is large enough to allow for an extension of the incision, additional incisions, drain placement or shifting of the drapes, says AORN.
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4. Most alcohol-based preps need a dry time of at least ____________________.

• a. 3 minutes
• b. 5 minutes
• c. 12 minutes
• Reveal

  • a. 3 minutes. While it's important to read the product's directions for use, most prep manufacturers say preps that contain isopropyl alcohol and give off flammable vapors should dry for at least 3 minutes before draping the patient or activating an ignition source, such as an electrocautery device. AORN also notes that it is important to not let the prep pool during application — if excess solution drips off of the patient, remove soaked materials such as drapes, gowns and towels before using an electrosurgical device.
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5. True or false: There is no harm in applying too much prep to the skin.

• a. True
• b. False
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  • b. False. Applying excess amounts of prep can cause it to pool under the patient. Pooled solution can cause irritation or give your patients a chemical burn, according to the Association of Surgical Technicians (osmag.net/BWuq7E). The organization recommends placing sterile towels at the periphery of the skin prep boundaries to aid in the prevention of pooling prep. Cover ECG leads, electrosurgical dispersive electrodes and tourniquets by an adhesive, clear plastic drape to prevent the accumulation of prep fluids and prevent chemical burns. If prep solution makes contact with any of those items, they should be replaced, according to the Association of Surgical Technicians.
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6. True or false: A patient scheduled for surgery should shower the night before the procedure.

• a. True
• b. False
• Reveal

  • a. True. Most leading infection prevention organizations now recommend that patients take a shower or bath the night before and/or the morning of surgery using either soap or an antiseptic solution.

    While the CDC doesn't recommend a CHG antiseptic solution over plain old soap, if you choose to have patients go the extra step, it's important to provide clear pre-op instructions on how to use the solution. The Association of Surgical Technologists notes that facilities should tell all patients 3 important things: that CHG is inactivated by soaps and shampoos, that CHG is an eye irritant and that the patient should not use body lotion after bathing.
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