Surgical Prep

Objectives
 Know the indications and contraindications of
various prep types.
 Describe prepping patterns for various body

sites
 know where to find guidelines for use of

various surgical preps.

 The Purpose of the prep is to render the
surgical site as free as possible from
infectious organisms.
Prepping for Prep
 Hair Removal should as close to the time of
surgery as possible without actually being
done in the OR
 Patients are asked to shower the night before

surgery and may be given CHG wipes to use

at home.
 If the area is visibly dirty you may want to

consider washing it with soap and water prior

to the final surgical prep.
 Consider “contaminated” areas like

fingernails, toes, skin fold and the umbilicus.

Types of Prep
Chlorhexidine Gluconate (2%) and EtOH(70%)
 Antibacterial action lasts up to 4 hours
 Effectiveness decreased by the presence of

soaps, rinse thoroughly if pre-washing.

 Not absorbed through intact skin
 Ototoxic and an Eye irritant, should no be

used on the face.

e.g. Chloraprep
 Flammable while wet 3
minutes to dry
 May cause irritation on

infants <2months
 Effective area 13.2”x13.2”
Types of Prep
Betadine (povidine iodine)
 Works well alone or when combined with
soaps
 Virtually non-irritating to mucous

membranes (5% sol’n OK for eye prep)

 Should be left on skin at least 2 minutes.
 OK to use on infants >2months
Povidone Iodine Scrub/Paint
Types of Prep
Iodine & EtOH e.g. Duraprep
 Cannot be used on face or in eyes due to

alcohol content
 Does not wash off, use “remover lotion” after

case
 Use with caution on infants <2 months.
Types of Prep
Hibiclense (CHG)
 Used in cases of iodine allergy where chloraprep is

not possible. Eg, broken skin, mucous membranes.

 Not necessary to
dilute
Types of Prep
Castille Soap
 When you can’t use any other kind of prep
due to sensitivities.
 Comes in concentrated packs
 Scrub with soapy water and rinse
 Ok to use in vaginal prep
Prepping Theory
 Clean  Dirty
 Start with Surgical site
 Do not re-do an area
Special Cases: Eyes
 No more than 5% betadine (no soap)
 Do not clip or shave eyebrows
 Start from where eyelids meet extend

outward
 Make sure prep

contacts eyelashes.
Special Cases: Mouth
 Usually Peridex, Betadine can be used.
 Provide toothbrush
 Mouth cases will always be considered

“contaminated
Quiz: Which Prep?
 ORIF closed ankle fracture
 Delayed primary closure of traumatic

abdominal wound.
 Laparoscopic appendectomy
 Pyloromyotomy on a 6 week old infant
 Cataract surgery
 Laparoscopic assisted vaginal hysterectomy
 Facial laceration on pt with shellfish allergy
Post –Op
Do I wash off this prep?
 Betadine
 Chrloroprep
 Duraprep
 Hibiclense
 Castille Soap