Peri Operative Skin Preparation - Adults



Canberra Hospital and Health ServicesClinical GuidelinePeri Operative Skin Preparation-AdultsContents TOC \h \z \t "Heading 1,1,Heading 2,2" Contents PAGEREF _Toc502654825 \h 1Guideline Statement PAGEREF _Toc502654826 \h 2Scope PAGEREF _Toc502654827 \h 2Section 1 – Equipment PAGEREF _Toc502654828 \h 2Section 2 – Procedure PAGEREF _Toc502654829 \h 3Section 3 – Preoperative Preparation Sites and Special Instructions PAGEREF _Toc502654830 \h 3Related Policies, Procedures, Guidelines and legislation PAGEREF _Toc502654831 \h 4Definition of Term PAGEREF _Toc502654832 \h 5References PAGEREF _Toc502654833 \h 5Attachments PAGEREF _Toc502654834 \h 5Attachment 1: Preoperative Skin Preparation PAGEREF _Toc502654835 \h 6Guideline StatementPurposeThe purpose of this document is to provide guidance for health care professionals to prepare the skin prior to surgery in order to:Minimise the number of microorganisms thereby reducing the risk of infection.To provide a suitable operating field.In the preparation of an operative site, the preferred method of hair removal is by clipping with an electric clipper. Preoperative clipping is to be performed as close to the theatre time as possible. AlertA new blade for the clean electric clipper is used for each operative site preparation and for each new patient. Back to Table of ContentsScopeClipping of operative sites will only be carried out if specifically requested by the medical officer. The patient may, in certain circumstances, perform their own preoperative clip. Dependent upon the Medical Officer’s preference, the preoperative clip can be attended in the preoperative ward, Day of Surgery Admissions Unit or within the Operating Theatre. The registered nurse of the area is ultimately responsible for ensuring the surgical site is prepared according to this guideline.The preoperative clipping can be attended by the following staff:Medical Officers,Registered nurses and registered midwives,Enrolled nurses,Wards person,Medical and nursing students under direct supervision.Back to Table of ContentsSection 1 – EquipmentScissorsElectric clipper with disposable bladeDisposable touch dry ‘Kylie’Light sourceElastoplastPersonal Protective Equipment (PPE)Back to Table of ContentsSection 2 – ProcedureCheck patient ID and gain consent for proposed preoperative skin preparation and hair clipping as per Section 3 Preoperative Preparation Sites and Special Instructions. Referring to the following policies CHHS Clinical Procedure – Patient Identification and Procedure Matching CHHS Policy: Consent and TreatmentAscertain the area to be clippedExplain procedure to patientEnsure privacyPosition patient and cover with a sheetProvide adequate lightingAttend to hand hygiene and don PPE (gloves) as per CHHS Clinical Procedure: Healthcare Associated Infections Clinical ProcedureClip long hair with scissorsUsing cleaned electric clippers, clip in the direction of the hair growth, holding the skin with the other hand.Note: Special care is to be taken over keloid tissues and bone prominences.In the ward areas and Day of Surgery Admissions, the patient should shower post clipping to remove loose hair. Within theatres, remove loose hair with sticky surgical tape such as Elastoplast, post clippingRemove PPE and attend to hand hygieneEnsure that a registered nurse inspects the clipping prior to surgeryDocument in the patient clinical record the completion and site of the clipping. If clipping has been completed in theatre, documentation on the Intra-Operative Nursing Care Plan must be completed.Report and record any abrasions or skin blemishes on the preoperative checklist and in the patient's clinical recordSign the preoperative checklist.Back to Table of ContentsSection 3 – Preoperative Preparation Sites and Special InstructionsThe preoperative preparation sites and special instructions are represented in Attachment 1 and are to be followed unless a medical officer has given specific instructions. The sites have been alphabetically categorised and placed under the headings listed below:Cardiac SurgeryEar, Nose, Throat, and EyeGeneralGynaecologyNeurologyOrthopaedicPlasticThoracicThoracic-abdominalUrology/NephrologyVascularBack to Table of ContentsRelated Policies, Procedures, Guidelines and legislationPoliciesHealth Directorate Nursing and Midwifery Continuing Competence PolicyCHHS Policy: Consent and TreatmentAdministration of Hospital Admissions and Discharges PolicyCHHS Clinical Policy: Patient Identification and Procedure Matching PolicyProceduresCHHS Clinical Procedure: Admission Discharge-Adults, Pregnant Women and NeonatesCHHS Clinical Procedure: Healthcare Associated Infections Clinical ProcedureCHHS Clinical Procedure: Falls Prevention and ManagementCHHS Clinical Procedure: Clinical Handover ProcedureCHHS Clinical procedure- Pressure Injury Prevention and Management: Adults, Children and NeonatesCHHS Clinical Procedure – Patient Identification and Procedure MatchingLegislationHealth Records (Privacy and Access) Act 1997Human Rights Act 2004Work Health and Safety Act 2011Health Practitioner Regulation National Law (ACT) Act 2010Health Records (Privacy and Access) Act 1997Health Regulation (Maternal Health Information) Act 1998 Human Rights Act 2004Privacy Act 1988Children and Young Peoples Act 2008 Guardianship and Management of Property Act 1991 Medical Treatment (Health Directions) Act 2006Back to Table of ContentsDefinition of TermsThrough clip: includes the removal of pubic hair from the symphysis pubis area, the external genitalia, the perineum, including the area around the anus, and the buttocks.Back to Table of ContentsSearch Terms Peri operative, peri op, skin, prep, preparation.Back to Table of ContentsReferencesWenzel R, Prevention and Control of Nosocomial Infections (1997) 3rd EditionWilliams and Wilkins Baltimore, London: pg.527The Joanna Briggs Institute, Preoperative Skin Preparation: Hair Removal, Best Practice (27/11/2015) (JB1197)5 moments of Hand Washing- Hand Hygiene Australia Health Organisation (WHO) Guidelines on Hand Hygiene in Healthcare B, Pre-Operative Clipping: Identifying the best tools and practices for infection prevention (17/6/2016)Spencer M, Pre-Operative Surgical Clipping: New Advances in Efficiency and Infection Prevention (5/4/2016) (1/1/18)Back to Table of ContentsAttachmentsAttachment 1: Preoperative Skin PreparationDisclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Policy Team ONLY to complete the following:Date AmendedSection AmendedDivisional ApprovalFinal Approval 02 January 2018Full RevisionExecutive Director, SOHCHHS Policy Committee This document supersedes the following: Document NumberDocument NameCHHS12/187Skin Preparation Standard Operating ProcedureAttachment 1: Preoperative Skin PreparationSURGICAL PROCEDURESPECIAL INSTRUCTIONSPREOPERATIVE SITE PREPARATIONCARDIAC SURGERYCoronary Artery BypassMitral Valve ReplacementAtrial Valve ReplacementClip hair from mid axilla, arms, both legs (for Coronary Artery Bypass only), pubic, full chest and abdomen shave. Shower with skin wash (Microshield) (after hair clipping has been performed) evening and morning prior to surgeryEAR, NOSE, THROAT, EYEEar SurgeryTympanoplastyStapedectomyMastoidectomyMyringoplastyOssicular repositioningWash hairWash hairWash hairWash hairWash hairNo preparationNo preparationNo preparationNo preparationNo preparationNasal SurgeryNo preparationThroat Surgery No preparationMouth SurgeryTonsillectomyDental ProceduresMajor Jaw ReconstructionWiring Fractured Jaw Clean teeth with toothpaste and brush and give patient a mouthwash.Clean teeth with toothpaste and brush.Give patient mouthwash. Wash hair. Shave male patients, face and neck.If possible give the patient a mouthwash.No preparation?No preparationNo preparation for female?No preparation Eye SurgeryNo preparation unless ordered, eg: eye drops Alert: Cutting of eyelashes is not performed.No preparationGENERALAppendicectomyRemoval of Axillary GlandsGynaecomastiaExcision of Breast LumpSimple MastectomyPrepare area from umbilicus to top of thighs. No visible hair when legs are together. No through clip required.Prepare area from the neck to below the breast from midline to bed-line on the affected side. The upper arm from shoulder to elbow including the axilla is also clipped.RADICAL MASTECTOMYBreast Lump (frozen section)MastectomyPrepare area from neck to umbilicus and laterally from 2/3 of front around to midline back.Include clipping the underarm and axilla to the elbow on the affected side. HERNIAInguinal HerniaFemoral HerniaPrepare area from the umbilicus to the mid-thigh of the affected side, as well as a through clip.OPERATIONS OF THE NECKRemoval of Parotid Gland or Calculus.Scalene Node Biopsy.Brachial Cyst Removal.Cervical Rib Excision.Total Laryngectomy.Radical Excision of Glands of Neck.Removal of Thyroid Adenoma.Scalenotomy.Thyroidectomy.Excision Pharyngeal Diverticulum.Carotid EndarterectomyMediastinoscopyClip area from bottom lip, throat and down to the nipple line. From shoulder to shoulder and including the back of the neck.Alert: A shave is not required for women.UPPER ABDOMINAL All general Laparoscopic procedures.Cholecystectomy.Colectomy.Splenectomy.Gastrectomy.Oversew of Ruptured Gastric Ulcer.Ileo-jejunal By-pass.Laparotomy.Pyloplasty.Vagotomy.Hiatus Hernia - Abdominal Approach.Celestin Tube Insertion.Ivor Lewis Procedure.?Prepare area from the level of the nipple to the upper thighs including external genitalia. Laterally it extends around the body to the bed-line on either side.LOWER ABDOMINALHemicolectomyAbdominal - Perineal Resection of ColonPull through operation of ColonPrepare area from nipple line to mid-thigh, bed-line to bed-line including external genitalia and through clip to posterior mid-thigh.Haemorrhoidectomy.Pilonidal Sinus.Peri-anal ProceduresSigmoidoscopyLords ProcedurePrepare area for the buttocks from the level of the iliac crest to the upper third of the thigh, including the anal region No preparationNo preparationGYNAECOLOGYLaparoscopyLaparoscopic SterilisationCautery of CervixDilation and CurettageCone Biopsy of Cervix Shirodkar Suture of CervixHysterosalpingogramTermination of PregnancyInter-uterine Device InsertionBartholin’s Cyst-MarsupilisationBartholin's AbscessVaginal repair - Anterior and PosteriorVaginal HysterectomyMarshall MarchettiClip pubic hair only. Check medical officer's preference.Check medical officer's preferencePrepare area from umbilicus to the upper level of the thighs include genitalia and perineal regionPrepare area from umbilicus to the upper level of the thighs include genitalia and perineal regionPrepare area from umbilicus to the upper level of the thighs include genitalia and perineal regionNo preparation No preparationNo preparationNo preparationNo preparationNo preparationNo preparationNo preparationNo preparationAs aboveAs aboveAbdominal HysterectomyAbdominal Tubal LigationCaesarean SectionEctopic GestationOophorectomyOvarian CystectomyOvarian Cyst RuptureSalpingectomyTubal Re-anastomosisVentrosuspensionPrepare area from level just below the breasts, bed-line to bed-line, to the upper thigh. No visible hair when legs are together.NEUROSURGERYAnterior Cervical ProceduresCraniotomy/Posterior Cervical ProceduresCloward's Cervical FusionCheck medical officer's preference.Preparation attended in the Operating Room.Prepare area from the lobes of both ears to the shoulders including both axillae.Alert: Female patients - do not prepare neck.The graft site is prepared from the waist to mid-thigh and laterally from the bed-line to bed-line. (The immediate pubic area is excluded). The medical officer may indicate which iliac crest is to be used. Prepare from midline to bed-line on that side.No preparationORTHOPAEDICSSpinal FusionLumbar LaminectomyPrepare area from the level of the axillae downward to upper thigh, bed-line to bed-line. No through clip required.Hand and Wrist OperationsFinger InjuriesRelease of Carpal TunnelClean fingernails. The clipped area extends from fingers (if hairy) to elbow, round the whole circumference of the arm.Alert: Do not clip female patient’s hand or armElbow OperationsTennis Elbow CorrectionOpen Reduction of Olecranon Process.Prepare area from the wrist to the top of the upper arm (not axilla) around the whole circumference of the arm.Knee OperationsMeniscectomyTotal Knee ReplacementKnee ReconstructionPatellectomyPrepare area from mid-thigh to mid-calf around the whole circumference of the leg.Foot OperationsKeller's OperationSilastic Implant to ToesTotal Ankle ReplacementPrepare area from the toes to the mid-calf around the whole circumference of the calf and foot.Clean toe nailsHip Surgery (Unilateral)Austin Moore ProsthesisTotal Hip ReplacementInnominate OsteotomyInternal Fixation of # Neck of Femur Prepare area from waist to ankle including the whole circumference of the leg on the affected side. A through clip including peri-anal is requiredShoulder OperationsPutti PlattTotal Shoulder ReplacementPrepare area from neck to waist and to the midline both anteriorly and posteriorly. The affected shoulder, axilla and circumference of the arm to the wrist are included.Iliac Crest OperationsDonor Site for Bone GraftPrepare area from the waist to the top of the thighs both anteriorly and posteriorly excluding the immediate pubic area.PLASTICSSkin Graft Donor Sites:ThighUpper or Lower Limb?Face and ScalpBat EarsAlert: Obtain specific orders from medical officer before commencing site preparation.General guidelines only included here:Circumferential clip from groin to knee. No pubic clip required. Clean finger or toe nails. Do not clip unless specifically ordered.?Alert: NEVER clip or shave eyebrows. Long hair to be plaited and centred on crown of head.THORACICThoracotomyLobectomyPneumonectomyBronchoscopyOesophagoscopyPrepare area from 2/3 of back around affected side to 2/3 of front.Neck to umbilicus; include underarm and axilla to mid-forearm clip on affected side.No preparationNo preparationPacemaker ImplantationThe prepared area includes a 18cm x 18cm square over the area. Check with the medical officer. Female patients may not require clippingMediastinoscopyPrepare area from mid-neck, bed-line to bed-line, under chin and downward in an arc from shoulder tip to shoulder tip. Prep down to nipple line.THORACIC-ABDOMINALExcision Hydatid Cyst.Thoraco-Abdominal Gastrectomy.Hepatectomy.Oesophagectomy.Ruptured Diaphragm.Ruptured Liver.Hiatus Hernia - Thoracic approach.Prepare area from neck to mid-thigh at the front, 2/3 of affected side including the affected axilla and arm to the elbow. The back area extends from neck to upper third of buttocks, 2/3 of affected side including the arm to the elbow.No through clip required. Clip visible pubic hair onlyUROLOGY / NEPHROLOGYUretersRe-implantation of Ureter.Partial or Total CystectomyPrepare area from the nipple. A through shave is not required. Clip visible pubic hair only.KidneysNephrectomyNephropexyNephro-ureterectomyPercutaneous Nephrolithotomy (PCNL)Prepare area from nipple to groin. Laterally it covers the circumference of the torso excluding the buttocks.Scrotum, Testes & ProstateTrans Urethral Resection of ProstrateProstatectomy (Open)OrchidopexyVaricoceleHydroceleLigation of Spermatic VeinUltrasonic LithotomyPrepare area from umbilicus to mid-thigh, bed-line to bed-line, including through clip.Peri-anal clip not required.Prepare area from umbilicus to mid-thigh, bed-line to bed-line, including through clip.Prepare area from umbilicus to mid-thigh, bed-line to bed-line, including through clip.Prepare area from umbilicus to mid-thigh, bed-line to bed-line, including through clip.Prepare area from umbilicus to mid-thigh, bed-line to bed-line, including through clip.As aboveAs aboveAs aboveBladder and Prostate Includes all bladder or prostate operations except Trans Urethral Resection of ProstatePrepare area from waist to symphysis pubis, bed-line to bed-line. No through clip required.UrethroplastyClip hair to 1/4 on scrotum and penis, shorter on pubic area. The area extends from umbilicus to upper thigh, bed-line to bed-line.Alert: Check with the medical officer regarding full or half presentationLoin LesionPrepare area from midline of back to bed-line, from below axilla to mid-buttocks.VASCULARLeg AmputationBelow Knee AmputationPrepare area from mid-thigh to ankle on affected leg, front and back.Above Knee AmputationPrepare area anteriorly from the iliac crest to mid-calf on the affected side. Posteriorly clip from below buttock to mid-calf on the affected side. A full pubic clip is required.Aortic and Iliac EndarterectomyPrepare area from the nipples to the ankles, bed-line to bed-line. No visible hair when legs together.Aortic AneurysmOesophagectomyPulmonary EmbolectomyPrepare area from the chin to the groin and laterally from bed-line to bed-line including the axilla and top of upper arms.Popliteal EndarterectomyObtain specific orders from the medical officer ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download