Definition
Skin preparation or surgical site preparation refers to the preoperative treatment of the intact skin of the patient and includes not only the immediate site of the intended incision, but also the broader area of the skin. It is a preoperative procedure performed to decontaminate and reduce the number of organisms on skin to eliminate the transference of sch organisms into the incision site.
Purposes
- To remove dirt and oil from a well-defined area.
- To prevent post-operative wound infection by reducing the number of microorganisms on the skin surface.
Methods Of Hair Removal
- Wet shaving
- Clipping
- Use of depilatory cream.
Articles
- Razor set.
- New blade.
- Soap.
- Bowl with water.
- Rag pieces or paper tissues.
- Kidney basin.
- Mackintosh or waterproof pad.
- Basin with water.
- Sponge towel.
- Bath towel.
- Duster.
- Depilatory cream optional.
- Electric clippers, if clipping is to be done.
- Clean gloves,
- Scissors.
Procedure
| Nursing action | Rationale | |
| 1 | Before procedure Inspect general condition of skin | If lesions, irritation or signs of infection are present, shaving should not be done. These conditions increased chances of postoperative wound infections. |
| 2 | Review physician’s order or the agency procedure book for specific area to be shaved | Extent area for hair removal depends upon site of incision, nature of surgery, and physician’s preference. |
| 3 | Assess patient ‘s understanding and acceptance of the purpose of hair removal. | Patient may be anxious regarding removal of hair and implication |
| 4 | During procedure Wash hand | Reduce risk of transmission of microorganisms. |
| 5 | Close room doors or bedside curtains and raise bed to working level. | Provide risk of transmission of microorganism. |
| 6 | Position patient comfortable with surgical site accessible | Shaving and skin preparation can take several minutes. Nurses should have easy access to hard-to-reach areas. |
| 7 | Don clean gloves. | |
| 8 | Remove hair: Wet shavePlace towel or waterproof pad under body part to be shaved. Drape patient with bath blanket, leaving only the area to be shaved at one time, exposed. Cut long hair short with scissors. Lather skin with gauze sponges dipped in antiseptic soap. Shave small area at a time. With nondominant hand hold gauze sponge to stabilize skin. Hold razor at 45degree. angle in dominant hand and shave in the direction of hair growth. Use short gentle strokes. Rinse razor in basin of water as soap and hair accumulate on the blade. Change and discard blades as they become dull. Rearrange bath blanket as each portion of shave is completed. Use wash cloth and warm water to rinse away remaining hair and soap solution from skin. Change water as needed. If shaved area is over body cervices, for example, umbilicus or groin, cleanse with, for example, umbilicus or groin, cleanse with cotton tipped applicators or cotton balls dipped in antiseptic solution. Dry cervices with cotton balls or pad. Observe skin closely for any nicks or cuts.Observe skin closely for any nicks or cuts. ii. Hair clipping Lightly dry area to be clipped with towel. Hold clippers in dominant hand, about 1 cm above skin, and cut hair in direction it grows. Clip small area at a time. Rearrange drape as necessary. Lightly brush off cut hair with towel. When clipped area is over body crevices, clean cervices with cotton tipped applicators or cotton balls dipped in antiseptic solution, then dry. iii. Depilatory hair removal Apply depilatory cream to the area (before application of cream sensitivity test to be done by applying a small amount of cream on skin on inner aspect of forearm or wirst. Check for any sensitivity reaction like redness, rashes, or itching of skin after 15-20 minitses). Wait for the required number of minutes and wipe off the cream with rag pieces or paper towel. Wash skin and rinse thoroughly. | Prevent soiling of bed linen Prevents unnecessary exposure of body parts and reduces patient’s anxiety. Lathering with antiseptic soap softens hair and reduces friction from razor. Shaving small area minimizes chances of cutting skin. Shaving in the direction of hair growth prevents pulling of hair. Maintains clean sharp razor edge to reduce patient’s discomfort. Maintains patient comfort and privacy. Reduces skin irritation and allows good visualization of the skin. Removes secretions, dirt, and other remaining hair clippings which harbor microorganisms. Reduces maceration of skin retained moisture. Reduced spread of microorganisms. Any break in skin integrity increases risk of wound infection. Removes moisture which interferes with clean cut of clippers. prevents pulling on hair and abrasion of skin. Prevents unnecessary exposure of body parts. Removes contaminated hair and promotes comfort. Improves visibility of area being clipped. Removes secretion dirt hair clippings which harbor microorganisms. Hair removal by depilation offers the primary advantage of leaving skin intact and free from cuts. If the patient is not sensitive to the depilatory preparation, it is a safer method of hair removal than shaving. Hair is removed simultaneously with wiping off the depilatory cream removes microorganisms from the skin. |
| 9 | Inform patient that procedure is completed. | |
| 10 | Clean and dispose of articles according to policy, do not recover razor blade. Dispose of gloves. | Reduces spread of infection and reduces risk of injury from razor blades. |
| 11 | After procedure Wash hand | Reduces risk of spread of microorganisms |
| 12 | Record procedure, area clipped or shaves and condition of skin before and after shaving in nurses’ notes | Documents status of surgical site for comparison over time. |
| 13 | Inspect /check patient to be sure that sheets are dry, bath blanket is removed, hospital clothing is being worn, and patient is placed in comfortable position. | |
| 14 | Report any skin alterations or nicks or cuts in skin to surgeon. | Skin problems may pose serious risk for postoperative infections. |
SITES FOR SURGICAL PREPARATION VARY DEPENDING ON TYPE OF SURGERY TO BE PERFORMED
Head and Neck
The site extends from above the eyebrows over the top of the head and includes the ears and both anterior and posterior areas of the neck and face. In females, face is not shaved of the neck and face.
Lateral Neck
Clean the external auditory canal with a cotton swab. Anteriorly, prepare the side of the face from above the eat to the upper thorax to just below the clavicle. Posteriorly prepare from neck to the spine including the area above the scapula.
Chest Surgery
The sine extends from the neck to the umbilicus and us the lateral midline.
Abdominal Surgery
The preparation site extends from axilla to the mind thighs extending bilaterally to the lateral midline. All visible pubic hair should be shaved
Perineal Surgery
Shave all pubic hair and the inner thighs to the mid-thigh. The area starts above the pubic lone anteriorly and extends beyond the anus posteriorly.
Lumbar Spine Surgery
Shave entire back including shoulders and neck to hairline and down to knees including both axilla
Rectal Surgery
Shave the buttocks from iliac crest down to the upper third of the thighs including the anal region. The area extends to the midline on each side
Flank Surgery
It extends anteriorly from the axilla down to the upper thigh including external genital area. Posteriorly, the area extends from mid scapular to the mid gluteal regions.
Hand and Forearm Surgery
The area includes the full circumference of the affected hand from axilla to the fingertips.
Lower Extremity Surgery
The area includes the area from umbilicus anteriorly including the entire leg, toes, and foot of the affected leg and posteriorly from top of buttocks to the heel,
Lower Leg Surgery
The area to be prepared includes the circumference of the entire leg from mid-thigh to toes of the affected leg
Special Consideration
The site for preparation may vary according to the surgeon’s preference.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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