Skin prep methods

RE: Skin prep methods

Robyn — Wed, 27 Sep 2017 15:32:18 GMT

I vaguely remember reading into all of this earlier in the year and being a little unsure! I remember the back and forth technique having been shown to reduce bacterial load better than the circular technique, so I just incorporated it. What I now do is:

30s back and forth over incision site
30s back and forth working my way out to one side, then the other
Repeat until clear of gross contamination, if any
Then concentric circle scrub as I would have before until happy I'm contamination free
Scoosh with surgical spirit/hibitane

Edit: Which, from reading Rob's post a little more carefully, looks fairly similar to the recommendation!

RE: Skin prep methods

Nessa Harbottle — Sun, 17 Sep 2017 21:30:31 GMT

Hi Rob

I am a student veterinary nurse and I am writing my peri-operative assignment. I have to research the aims of skin preparation, techniques and procedures. At my practice we still prep the patient's skin with chlorhexidine and use the circular technique. I have downloaded the article from your website but was wondering if you have any other resources that I can use.

Also I will speak to my practice manager to see if you can visit the practice and teach the new technique.

Re: Skin prep methods

bongo — Mon, 06 Oct 2014 16:20:46 GMT

The back and forth motions are only very small rather than back and forth from the surgical site to periphery and back again if this makes sense?

Re: Skin prep methods

Rob Watkins — Mon, 06 Oct 2014 10:43:17 GMT

Hi Jill

Thanks for posing the question.

The initial prep should be viewed as primarily removal of gross contamination.

It should focus on the incision site in a back and forth motion. This is then repeated on the peripheral area in short movements.

Once swabs are clean the patient is then moved to theatre for final prep.

The final prep should be applied with friction... that is different to scrubbing.

It should ideally be a 2% CHG/70% IPA solution. Again ideally this should be done with a sterile applicator/solution.

A gentle back and forth motion focussing on the incision site for 30 seconds before moving to cover the peripheral area. This will provide sufficient abrasion and contact time.

I travel the country with fake skin in the boot of the car... So if anyone wants me to stop by and show them the technique... just PM me.

Re: Skin prep methods

Nick Shackleton — Sun, 05 Oct 2014 20:17:02 GMT

Here is how I prep a patient ready for surgical intervention. First prep down in prep area. Clip first with the fur to take off most hair. Then against the fur to get a close clip. I have always used lint free gauze swabs and prevent bits been left on incision site. Wear gloves. Using a 50/50 hibiscrub/water mix. I have always done circular motions starting at the incision site and working my way out. Once reaching Unclipped area discarding the swab. Continue until swabs are coming away clean. Using hibitane/water/surgical spirit mix spray the area. In bicycle spoke motion using dry swabs outwards from incission site to edge. Move patient to theatre. Using 50/50 hibiscrub/water. Use swabs and perform bicycle spoke motion starting at centre outwards and discard. The repeat spraying with hibitane/water/spirit mix and then allow to dry prior to draping.

Re: Skin prep methods

Jill Macdonald — Sun, 05 Oct 2014 14:50:37 GMT

I'd like to ask the same question.. I've read the update (thanks Rob) but I'm still not quite sure how the back and forth technique should be used, without 're-contaminating' the surgical site.

I'm also not quite clear on what the current thoughts on final prep are. The article says:

"Final skin preparation This should be performed in the theatre wearing sterile gloves. Traditional methods of prep have included re-scrubbing the patient or applying an alcohol spray or rinse. However rinsing or spraying the surgical site does little more than soak the area4 and the use of multi use containers poses a significant risk of contamination. Scrubbing patients for a second time may lead to micro-abrasion of the skin which is implicated in raising bacterial skin counts."

This suggests that spraying just wets the site, and re-scrubbing can cause abrasions. So what is recommended? Is it just spraying with the chlorhex/isopropyl solution?

Thanks,

Jill

Re: Skin prep methods

Louise Hanley — Wed, 03 Sep 2014 14:38:32 GMT

Has anyone found step by step instructions for the back and forth method? I am due to do OSCE's soon as I qualified overseas and I have always done circular.

Thanks!

Re: Skin prep methods

Rob Watkins — Mon, 01 Sep 2014 11:34:58 GMT

Hi Erin

If you visit

http://www.invictavet.com/chloraprep.html

and click on the "free surgical update" tab you should find supporting information to answer your questions.

If you don't then feel free to PM me.

Best regards

Rob

Re: Skin prep methods

Erin Gibson — Mon, 01 Sep 2014 05:18:53 GMT

Hi I have just jumped online to also find out the answer to this question and wondered if you could share what you have found out?

Kind regards

Erin.

Re: Skin prep methods

joesmum — Tue, 10 Jun 2014 18:21:49 GMT

Thank you.

Re: Skin prep methods

Rob Watkins — Tue, 10 Jun 2014 10:07:31 GMT

Hi Joesmum

I've sent you a PM

Rob

Re: Skin prep methods

ragina falange — Fri, 06 Jun 2014 17:58:57 GMT

Hiya, yes we now use a scrubbing method back and forth, however we only do this around the surgical site and then towards the edge is when we discard the swab if that makes sense? And yes there is a pre made chlor hex/alcohol made up they are called chloroprep and come in 3ml or 10ml and we find them fantastic and dead easy to use! Unsure of the price!

Hope this helps!