Fundamentals of Nursing Q 539
Effective skin disinfection before a surgical procedure includes which of the following methods?
A. Shaving the site on the day before surgery.
B. Applying a topical antiseptic to the skin in the evening before surgery.
C. Having the patient take a tub bath on the morning of surgery.
D. Having the patient shower with an antiseptic soap on the evening before and the morning of surgery.
Correct Answer: D. Having the patient shower with an antiseptic soap on the evening before and the morning of surgery
Studies have shown that showering with an antiseptic soap before surgery is the most effective method of removing microorganisms from the skin. Procedural and surgical site infections create difficult and complex clinical scenarios. A source for pathogens is often thought to be the skin surface, making skin preparation at the time of the procedure critical. The antiseptic used for bathing should be approved using the testing criteria from the FDA’s Tentative Final Monograph (TFM) for Antiseptic Drug Products for preoperative skin preparation. The goal for this recommendation would be to reduce the number of bacterial flora at the patient’s incision site.
Option A: Shaving the site of the intended surgery might cause breaks in the skin, thereby increasing the risk of infection; however, if indicated, shaving, should be done immediately before surgery, not the day before. The purpose of surgical skin preparation is to reduce the number of microorganisms on the skin’s surface. This is accomplished by removing dirt and oil without causing damage to the skin’s natural protective function or interfering with postoperative wound healing. The CDC’s 1999 guideline recommends that hair not be removed unless it interferes with the surgical procedure and is a Category IA recommendation.12 Also, according to AORN standards, “Whenever possible, hair should be left at the surgical site.”13 Hair-removal methods discussed are depilatory; dry clipped using an electric clipper and wet using a disposable razor.
Option B: A topical antiseptic would not remove microorganisms and would be beneficial only after proper cleaning and rinsing. The most common skin preparation agents used today include products containing iodophors or chlorhexidine gluconate (CHG). CHG has more sustained antimicrobial activity and is more resistant to neutralization by blood products than the iodophors. CHG is applied in a similar manner to PVP-I, but should not be used in the genital region. This agent has gained popularity as a hand-scrubbing and showering antiseptic prior to surgery, but also continues to be used as a patient skin preparation agent.
Option C: Tub bathing might transfer organisms to another body site rather than rinse them away. The CDC’s 1999 guideline states that the incision site should be clean before surgical skin preparation and has labeled this a Category IB.10 In the Standards, Recommended Practices, and Guidelines of the Association of periOperative Registered Nurses (AORN) it states, “The surgical site and surrounding areas should be clean.”