SKILL 30: Surgical Skin Preparation

1. Wear gloves
2. Make up antiseptic solution, following the dilution rates below (refer back to Skill 17 for calculations)
3. Starting at the proposed incision site, move the gauze back and forth for approximately 15 seconds.
   • Do not use a wiping action as it is not as effective at removing the contamination
4. Work outwards in C & L pattern, never returning to middle with the existing swab.
5. Discard swab and get a new one for new sections, as you move outwards.
   • Never return swab to the fresh bowl, as this will contaminate.
6. Continue until clean.
7. Spray the site with alcohol for the “rinse”. This helps remove detergent and defat the skin. You can also wipe at this stage, inside to out. Normally you would place on fresh gloves for this step (for training you can use existing).
8. Do a final paint, using chlorhex/meths (or other skin antiseptic) following the same C & L pattern with swaps, or you can also spray with the solution.
   • chlorhex/meths mix (0.5% chlorhexidine gluconate/70% alcohol) or chlorhexidine 0.2% (diluted with distilled water)

Swab Holding

When using gauze swabs, they should be folded into quarters by bringing the four corners together and held by the corners. This produces a smaller contact area that is easier to control and limits the chance of your fingers touching the patient.

Scrub Pattern

Allows you to keep the back and forth action going whilst working from the inside out.

Common Surgical Skin Preparation Dilutions

• Chlorhexidine Gluconate 4% SCRUB
  • Most manufacturers say to use undiluted!
  • 60:40 with warm tap water (60mL chlorhex and 40mL water for this demo)
  • Never less that 2% dilution
• Povidone Iodine 7.5% SCRUB (remember concentrations can vary between brands)
  • 50:50 with warm tap water