TL;DR
Surgical Skin Preparation: Antiseptic preparation of surgical site to reduce microbial count and SSI risk.
Surgical Skin Preparation
Definition
Antiseptic preparation of surgical site to reduce microbial count and SSI risk.
Equipment & Tools
Instruments and tools relevant to surgical skin preparation:
| Instrument | Category | Use |
|---|---|---|
| Bovie (ESU) | Electrosurgery | Cut (continuous waveform) and coag (interrupted waveform) modes for hemostasis |
| Metzenbaum scissors | Cutting/dissecting | Delicate tissue dissection, curved blades for undermining |
| Needle holder | Suturing | Holds suture needles, tungsten carbide inserts for grip, box lock mechanism |
| Kelly clamp | Clamping | Hemostasis on medium vessels, half-serrated jaws |
Step-by-Step Procedure
Procedural steps relevant to surgical skin preparation in the surgical setting:
- Initial count performed before incision: sponges, sharps, instruments, miscellaneous
- Closing counts: first closing count (deep layers), second closing count (skin closure)
- All counts are audible, visual, and concurrent (scrub tech and circulator together)
- Sponges counted in groups of 5, radiopaque sponges only used on the field
- Incorrect count protocol: notify surgeon then recount then wound search then X-ray if unresolved
- Sharps counted on a needle counter/magnet, broken needles: account for all pieces
- Add-on items must be counted when added and at subsequent count times
Common Errors
Surgical technology errors related to surgical skin preparation include:
- Breaking sterile technique without recognizing the breach
- Incorrect count procedures: sharps counted on a needle counter/magnet, broken needles: account for all pieces
- Passing instruments improperly. Always pass handles first, sharp-end protected
- Failing to communicate equipment needs before the procedure begins
Safety Considerations
Maintaining safety during procedures involving surgical skin preparation requires adherence to sterile technique:
- Moisture strikes through: wet drapes are contaminated, use impervious drapes and keep the field dry
- Movement around the sterile field must not cause air currents, no reaching over the field, no turning back to the field
- Sterile field is created as close to the time of use as possible and never left unattended
- Only sterile items may be placed on a sterile field
Patient Communication
Clear communication about surgical skin preparation with patients, families, and the healthcare team is essential. Use standardized handoff tools (SBAR) for shift changes and transfers. Verify understanding by asking the patient to repeat key information back to you.
Practical Example
In the OR: During a procedure involving surgical skin preparation, the surgical technologist may handle:
- Richardson retractor (Retraction): Deep abdominal retraction, handheld, curved blade
- Allis clamp (Grasping): Grasping tissue without crushing (bowel, fascia), traumatic teeth
- Kocher clamp (Clamping): Grasping heavy tissue (fascia), has teeth, NOT for vessels
Why It Matters
Technique, agent selection, and fire safety tested on CST exam.
Related Terms
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