Skin Prep

Skin Prep (General)

100

The goal of preoperative skin preparation is:

The removal of soil and transient microbes from the skin, The rapid reduction of resident microbes from the skin, The inhibition of rapid, rebound growth of these microbes,

200

List the criteria for an ideal pre-operative skin antiseptic agent:

Be non-irritating to the skin; Be broad spectrum and significantly reduce microorganisms on intact skin; Be fast acting and have a persistent effect; Remain effective in the presence of organic material; Be virucidal and active against protozoa and yeast; Be non-flammable for use with laser, electrosurgical or other high energy devices

300

If the presence of hair will interfere with the surgical procedure and removal is in the best interest of the patient, the following guidelines should be taken:

As close to the time of surgery as possible; Removed outside of the operating room theatre or procedure room ; Only hair interfering should be removed; Hair should be clipped using a single use clipper, or a clipper with a reusable head; Eyebrows shall not be shaved unless deemed essential

400

List the methods of applying a skin prep:

Expose only areas to be prepped, Clean to dirty, Remove jewelries, Start from incision site to periphery, Maintain aseptic technique, Dont backtrack, Follow the manufacturer's instructions, Remove a the end of the surgical procedure

500

How would you do a skin prep on graft and donor sites?

Graft and donor sites are prepared separately to prevent cross-contamination from one site to the other. The donor site is prepared first. Colorless antiseptic solutions allow the surgeon to evaluate the vascularity of the graft. Items used in preparation of the recipient site must not be permitted to contaminate the donor site.

Skin Flora

100

Two types of skin flora

Resident flora and transient flora

200

The type of bacteria that is always present and cannot be entirely removed from the skin surface

Resident flora

300

Carried in the nose, throat, axillae, toe webs and perineum of 30-50% of healthy people

Staphylococcus aureus

400

Called the "super bug" and found in about 2% of the population

Meticillin-resistant Staphylococcus aureus (MRSA)

500

If opportunity arises, some of the microbes are able to cause disease and become opportunistic pathogens. This can happen due to a number of different conditions which are:

When the immune system isn't working properly, normal flora can overpopulate or move into areas of the body where they do not normally occur. When the balance of normal microbes is disrupted, for example when a person takes a broad spectrum antibiotics, microbes that are normally crowded out by resident microbes have an opportunity to take over. Disease can result when normal flora are traumatically introduced to an area of the body that they do not normally occur in.

Skin Prep Solutions

100

The recommended standard solution to reduce SSI is

CHG with 70% isopropyl alcohol

200

The only skin antiseptic that destroys spores

Povidone-iodine

300

This antiseptic agent has a similar range of motion as hexachlorophene. Research has also shown that it alters hormone regulation in animals, might contribute to the development of antibiotic-resistant germs, might be harmful to the immune system

Triclosan

400

Why is the combination of CHG and alcohol considered more effective than when the agents are used alone

It combines the properties and antimicrobial activity of both substances to optimal effect: residual activity with rapid action, broad-spectrum agent

500

What are some considerations to take when using Chlorhexidine gluconate to do skin prep

Do not use with patients with known allergies to CHG. Avoid contact with the meninges; neurotoxic. Avoid contact with eyes, can cause corneal damage. Avoid contact with inner ears; can cause deafness. Prolonged skin contact may cause irritation. For lumbar puncture-make sure antiseptic solution is completely dry before commencing with the procedure. Do not use to prep stomas or open wounds. Should not be used in Infants less than 2 months of age (potential for skin irritation and increased drug absorption)

Surgical Site Infection (SSI)

100

The two possible sources of infection (explanation) and examples

Endogenous (self) infection - occurs when microorganisms are transferred from their original location to a vulnerable site on the same patient such as a wound, or the insertion point of an intravenous catheter. Exogenous infection - occurs when pathogenic microorganisms are spree from one person to another

200

Give 2 examples of a reservoir

Healthcare worker's hands, surgical instruments

300

The 5 components of the chain of infection

An infectious agent -> reservoir -> portal of exit -> mode of transmission -> portal of entry -> susceptible host

400

Prevention strategies to reduce SSI (Give 5)

Appropriate use of prophylactic antibiotics, Decolonization, Antiseptic Coated Suture, Maintenance of preoperative blood glucose control, Perioperative normothermia, Appropriate hair removal, Antiseptic use

500

Differentiate the 3 kinds of surgical site infections

Superficial incisional SSI is an infection that occurs at the incision site. A deep incisional SSI involves the deep soft tissue, e.g. fascia or muscle, of the incision. An organ/space SSI involves any part of the anatomy (e.g. organs or spaces) other than the skin incision, fascia, or muscle layers, which was opened or manipulated during the operation