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Perioperative Preparation of the Surgical Site: Hair Removal and Surgical Skin Preparation (2.21)

Perioperative Preparation of the Surgical Site: Hair Removal and Surgical Skin Preparation (2.21) - Policies, Clinical, UWHC Clinical, Department Specific, Surgical Services, Clinical

2.21

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

MAY 1987
ORIGINAL
 REVISION

MAY 2017
PAGE 1
OF 3
POLICY #

2.21
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER SURGICAL
SERVICES
TITLE
PERIOPERATIVE PREPARATION OF THE SURGICAL SITE:
HAIR REMOVAL AND SURGICAL SKIN PREPARATION

J:\Or\Sec\Policy & Procedure\2017\2.21 Final Preparation of the Surgical Site Hair Removal and Surgical Skin Preparation.docx

I. PURPOSE

The purpose of perioperative patient skin antisepsis is to reduce the risk of the patient developing a surgical site
infection (SSI) by removing soil and transient microorganisms at the surgical site.

II. POLICY

A. The surgical site will be verified with the surgeon, resident, or fellow. Refer to the Surgical Skin Preparation
Guidelines for recommended prepping agent. No prep agent should be diluted, except for eye procedures.
Follow manufacturer's directions on the bottle or packaging for all prep solutions. Store at room temperature,
avoiding excessive heat (above 104 θF/40 θC).
B. The patient’s skin and allergies will be assessed preoperatively and recorded in the patient’s clinical record.
When hair removal is required, clipping versus shaving should be used to avoid skin disruption and to further
reduce the risk of SSI.
C. Document in the patient’s clinical record will include the patient’s sensitivities or adverse reactions to the
surgical clip and prep, and when appropriate, confirmation that prep solution has dried prior to draping.
D. Before applying sterile drapes, allow sufficient time for evaporation of alcohol or alcohol-based preparation to
reduce the possibility of fire. Confirm that alcohol-based prep solution is dry prior to draping with surgical
team and document in the patient’s clinical record.
E. Prevent antiseptic agent from pooling beneath patient’s pneumatic tourniquet cuffs, electrodes, or
electrosurgical dispersive pads to reduce the risk of chemical burns.
F. Warmed IV solution and pour bottle saline and water for prepping are labeled by Central Supply with a two
week expiration date on the bottle. None of the prep solutions should be diluted, with the exception of eye
procedure preparations; however, when cleaning the surgical site before prepping, you may dilute the prep
solution. The warmer temperature for bottle and IV fluids is 104 θF. Once the fluids are removed from the
warmer, the fluid should not be returned to the warmer.

III. PROCEDURE
1. Preoperative Skin Preparation – Adult
A. All adult surgical patients will undergo a night before and morning of surgery full body treatment with
Chlorhexidine gluconate (CHG).
B. In addition, patients will be instructed not to shave their surgical incisional area prior to surgery.
C. The patient will receive a CHG treatment of the surgical incisional area on the morning of surgery, prior to
arrival to the operating room.
2. Preoperative Skin Preparation - Pediatric and Neonatal
A. All pediatric surgical patients will perform a full body treatment with Chlorhexidine gluconate (CHG) the
night before surgery.
B. In addition, patients will be instructed to avoid shaving their surgical incision area prior to surgery.
C. Patients having surgery where an incision will be made, will receive a second CHG treatment on the morning
of surgery, prior to arrival to the operating room.
D. Patients under the age of 32 weeks post menstrual age (corrected age) are excluded from the use of CHG for
preoperative skin preparation unless instructed by a physician.

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

MAY 1987
ORIGINAL
 REVISION

MAY 2017
PAGE 2
OF 3
POLICY #

2.21
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER SURGICAL
SERVICES
TITLE
PERIOPERATIVE PREPARATION OF THE SURGICAL SITE:
HAIR REMOVAL AND SURGICAL SKIN PREPARATION

J:\Or\Sec\Policy & Procedure\2017\2.21 Final Preparation of the Surgical Site Hair Removal and Surgical Skin Preparation.docx

3. Intraoperative Skin Preparation
A. Secure all necessary equipment and supplies.
B. Assess site area to be prepped before and after the clipping and prepping. Assess the patient’s allergy status
against prep solutions to be used.
C. Increase the room temperature to decrease the patient’s heat loss from increased skin exposure. Utilize forced
air warming blankets (i.e. Bair Paws/Hugger). Warm blankets kept in the warmers at 110 θF can be considered
to maintain body temperature.
D. Confirm the prep site with the physician.
E. Place impervious drapes around the prep site periphery as necessary.
a. Protect EKG leads, electrosurgical dispersive pad(s), tourniquet, etc. from moisture.
F. If hair removal is indicated, clip the surgical area.
G. Remove loose hair from the preparation site.
H. Perform hand hygiene and don sterile gloves prior to skin preparation.
I. Skin antiseptics should be applied using aseptic technique and according to the manufacturer’s instructions for
use. Exception will be made for adult genitourinary skin preparation based upon internal study and
recommendations from the Wisconsin Division of Public Health Supplemental Guidance for the Prevention of
Surgical Site Infections: An Evidence-Based Perspective.
J. Move from “incision site to periphery or area with lower bacterial count to area of higher bacterial count.”
K. The antiseptic should be allowed to dry for the full time recommended in the manufacturer’s instructions for
use before sterile drapes are applied. Confirm with the surgical team that the prepped area is dry and
document confirmation in the patient’s clinical record.

IV. REFERENCES

A. AORN Guidelines for the Preoperative Skin Antisepsis
B. CDC Guideline for Prevention of Surgical Site Infection - Centers for Disease Control and Prevention
C. Wisconsin Division of Public Health Supplemental Guidance for the Prevention of Surgical Site Infections:
An Evidence-Based Perspective

V. RESOURCES
A. UW Health Surgical Skin Preparation Guidelines
B. UW Health Principles of Surgical Skin Prep
C. 2% Chlorhexidine Gluconate (CHG) for Patient Pre-operative Vaginal Antisepsis Internal Study
D. UW Health Surgical Services Plan and Measurement Strategies for Preoperative Treatment with
Chlorhexidine gluconate (CHG) at American Family Children’s Hospital
E. UW Health Surgical Services Plan and Measurement Strategies for Preoperative Treatment with
Chlorhexidine gluconate (CHG) at University Hospital and the American Center


UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

MAY 1987
ORIGINAL
 REVISION

MAY 2017
PAGE 3
OF 3
POLICY #

2.21
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER SURGICAL
SERVICES
TITLE
PERIOPERATIVE PREPARATION OF THE SURGICAL SITE:
HAIR REMOVAL AND SURGICAL SKIN PREPARATION

J:\Or\Sec\Policy & Procedure\2017\2.21 Final Preparation of the Surgical Site Hair Removal and Surgical Skin Preparation.docx

REVIEWED BY
Surgical Services Policy and Procedure Committee
Infection Control Department

SIGNED BY
Anne Mork, Director of Perioperative Services