Canberra Hospital and Health Services
Clinical Guideline
Peri Operative Skin Preparation-Adults
Contents
Contents
Guideline Statement
Scope
Section 1 – Equipment
Section 2 – Procedure
Section 3 – Preoperative Preparation Sites and Special Instructions
Related Policies, Procedures, Guidelines and legislation
Definition of Term
References
Attachments
Attachment 1: Preoperative Skin Preparation
Guideline Statement
Purpose
The purpose of this document is to provide guidance for health care professionals to prepare the skin prior to surgery in order to:
- Minimise the number of microorganisms thereby reducing the risk of infection.
- To provide a suitable operating field.
In the preparation of an operative site, the preferred method of hair removal is by clipping with an electric clipper. Preoperative clipping is to be performed as close to the theatre time as possible.
Alert
A new blade for the clean electric clipper is used for each operative site preparation and for each new patient.
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Scope
Clipping of operative sites will only be carried out if specifically requested by the medical officer. The patient may, in certain circumstances, perform their own preoperative clip. Dependent upon the Medical Officer’s preference, the preoperative clip can be attended in the preoperative ward, Day of Surgery Admissions Unit or within the Operating Theatre. The registered nurse of the area is ultimately responsible for ensuring the surgical site is prepared according to this guideline.
The preoperative clipping can be attended by the following staff:
- Medical Officers,
- Registered nurses and registered midwives,
- Enrolled nurses,
- Wards person,
- Medical and nursing students under direct supervision.
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Section 1 – Equipment
- Scissors
- Electric clipper with disposable blade
- Disposable touch dry ‘Kylie’
- Light source
- Elastoplast
- Personal Protective Equipment (PPE)
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Section 2 – Procedure
- Check patient ID and gain consent for proposed preoperative skin preparation and hair clipping as per Section 3 Preoperative Preparation Sites and Special Instructions. Referring to the following policies
- CHHS Clinical Procedure – Patient Identification and Procedure Matching
- CHHS Policy: Consent and Treatment
- Ascertain the area to be clipped
- Explain procedure to patient
- Ensure privacy
- Position patient and cover with a sheet
- Provide adequate lighting
- Attend to hand hygiene and don PPE (gloves) as per CHHS Clinical Procedure: Healthcare Associated Infections Clinical Procedure
- Clip long hair with scissors
- Using cleaned electric clippers, clip in the direction of the hair growth, holding the skin with the other hand.
Note: Special care is to be taken over keloid tissues and bone prominences.
- In the ward areas and Day of Surgery Admissions, the patient should shower post clipping to remove loose hair. Within theatres, remove loose hair with sticky surgical tape such as Elastoplast, post clipping
- Remove PPE and attend to hand hygiene
- Ensure that a registered nurse inspects the clipping prior to surgery
- Document in the patient clinical record the completion and site of the clipping. If clipping has been completed in theatre, documentation on the Intra-Operative Nursing Care Plan must be completed.
- Report and record any abrasions or skin blemishes on the preoperative checklist and in the patient's clinical record
- Sign the preoperative checklist.
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Section 3– Preoperative Preparation Sites and Special Instructions
The preoperative preparation sites and special instructions are represented in Attachment 1 and are to be followed unless a medical officer has given specific instructions. The sites have been alphabetically categorised and placed under the headings listed below:
- Cardiac Surgery
- Ear, Nose, Throat, and Eye
- General
- Gynaecology
- Neurology
- Orthopaedic
- Plastic
- Thoracic
- Thoracic-abdominal
- Urology/Nephrology
- Vascular
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Related Policies, Procedures, Guidelines and legislation
Policies
- Health Directorate Nursing and Midwifery Continuing Competence Policy
- CHHS Policy: Consent and Treatment
- Administration of Hospital Admissions and Discharges Policy
- CHHS Clinical Policy: Patient Identification and Procedure Matching Policy
Procedures
- CHHS Clinical Procedure: Admission Discharge-Adults, Pregnant Women and Neonates
- CHHS Clinical Procedure: Healthcare Associated Infections Clinical Procedure
- CHHS Clinical Procedure: Falls Prevention and Management
- CHHS Clinical Procedure: Clinical Handover Procedure
- CHHS Clinical procedure- Pressure Injury Prevention and Management: Adults, Children and Neonates
- CHHS Clinical Procedure – Patient Identification and Procedure Matching
Legislation
- Health Records (Privacy and Access) Act 1997
- Human Rights Act 2004
- Work Health and Safety Act 2011
- Health Practitioner Regulation National Law (ACT) Act 2010
- Health Records (Privacy and Access) Act 1997
- Health Regulation (Maternal Health Information) Act 1998
- Human Rights Act 2004
- Privacy Act 1988
- Children and Young Peoples Act 2008
- Guardianship and Management of Property Act 1991
- Medical Treatment (Health Directions) Act 2006
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Definition of Terms
Through clip: includes the removal of pubic hair from the symphysis pubis area, the external genitalia, the perineum, including the area around the anus, and the buttocks.
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Search Terms
Peri operative, peri op, skin, prep, preparation.
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References
- Wenzel R, Prevention and Control of Nosocomial Infections (1997) 3rd Edition
Williams and Wilkins Baltimore, London: pg.527
- The Joanna Briggs Institute, Preoperative Skin Preparation: Hair Removal, Best Practice (27/11/2015) (JB1197)
- 5 moments of Hand Washing- Hand Hygiene Australia
- World Health Organisation (WHO) Guidelines on Hand Hygiene in Healthcare
- Zimmerman B, Pre-Operative Clipping: Identifying the best tools and practices for infection prevention (17/6/2016)
- Spencer M, Pre-Operative Surgical Clipping: New Advances in Efficiency and Infection Prevention (5/4/2016)
- (1/1/18)
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Attachments
Attachment 1: Preoperative Skin Preparation
Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.
Policy Team ONLY to complete the following:
Date Amended / Section Amended / Divisional Approval / Final Approval02 January 2018 / Full Revision / Executive Director, SOH / CHHS Policy Committee
This document supersedes the following:
Document Number / Document NameCHHS12/187 / Skin Preparation Standard Operating Procedure
Attachment 1: Preoperative Skin Preparation
SURGICAL PROCEDURE / SPECIAL INSTRUCTIONS / PREOPERATIVE SITE PREPARATIONCARDIAC SURGERY
Coronary Artery Bypass
Mitral Valve Replacement
Atrial Valve Replacement / Clip hair from mid axilla, arms, both legs (for Coronary Artery Bypass only), pubic, full chest and abdomen shave. Shower with skin wash (Microshield) (after hair clipping has been performed) evening and morning prior to surgery /
EAR, NOSE, THROAT, EYE
Ear Surgery
Tympanoplasty
Stapedectomy
Mastoidectomy
Myringoplasty
Ossicular repositioning / Wash hair
Wash hair
Wash hair
Wash hair
Wash hair / No preparation
No preparation
No preparation
No preparation
No preparation
Nasal Surgery / No preparation
Throat Surgery / No preparation
Mouth Surgery
Tonsillectomy
Dental Procedures
Major Jaw Reconstruction
Wiring Fractured Jaw / Clean teeth with toothpaste and brush and give patient a mouthwash.
Clean teeth with toothpaste and brush.
Give patient mouthwash. Wash hair. Shave male patients, face and neck.
If possible give the patient a mouthwash. / No preparation
No preparation
No preparation for female
No preparation
Eye Surgery / No preparation unless ordered, eg: eye drops
Alert: Cutting of eyelashes is not performed. / No preparation
GENERAL
Appendicectomy
Removal of Axillary Glands
Gynaecomastia
Excision of Breast Lump
Simple Mastectomy / Prepare area from umbilicus to top of thighs. No visible hair when legs are together. No through clip required.
Prepare area from the neck to below the breast from midline to bed-line on the affected side. The upper arm from shoulder to elbow including the axilla is also clipped. /
RADICAL MASTECTOMY
Breast Lump
(frozen section)
Mastectomy / Prepare area from neck to umbilicus and laterally from 2/3 of front around to midline back.
Include clipping the underarm and axilla to the elbow on the affected side. /
HERNIA
Inguinal Hernia
Femoral Hernia / Prepare area from the umbilicus to the mid-thigh of the affected side, as well as a through clip. /
OPERATIONS OF THE NECK
Removal of Parotid Gland or Calculus.
Scalene Node Biopsy.
Brachial Cyst Removal.
Cervical Rib Excision.
Total Laryngectomy.
Radical Excision of Glands of Neck.
Removal of Thyroid Adenoma.
Scalenotomy.
Thyroidectomy.
Excision Pharyngeal Diverticulum.
Carotid Endarterectomy
Mediastinoscopy / Clip area from bottom lip, throat and down to the nipple line. From shoulder to shoulder and including the back of the neck.
Alert: A shave is not required for women. /
UPPER ABDOMINAL
All general Laparoscopic procedures.
Cholecystectomy.
Colectomy.
Splenectomy.
Gastrectomy.
Oversew of Ruptured Gastric Ulcer.
Ileo-jejunal By-pass.
Laparotomy.
Pyloplasty.
Vagotomy.
Hiatus Hernia - Abdominal Approach.
Celestin Tube Insertion.
Ivor Lewis Procedure. / Prepare area from the level of the nipple to the upper thighs including external genitalia. Laterally it extends around the body to the bed-line on either side. /
LOWER ABDOMINAL
Hemicolectomy
Abdominal - Perineal Resection of Colon
Pull through operation of Colon / Prepare area from nipple line to mid-thigh, bed-line to bed-line including external genitalia and through clip to posterior mid-thigh. /
Haemorrhoidectomy.
Pilonidal Sinus.
Peri-anal Procedures
Sigmoidoscopy
Lords Procedure / Prepare area for the buttocks from the level of the iliac crest to the upper third of the thigh, including the anal region /
No preparation
No preparation
GYNAECOLOGY
Laparoscopy
Laparoscopic Sterilisation
Cautery of Cervix
Dilation and Curettage
Cone Biopsy of Cervix
Shirodkar Suture of Cervix
Hysterosalpingogram
Termination of Pregnancy
Inter-uterine Device Insertion
Bartholin’s Cyst-Marsupilisation
Bartholin's Abscess
Vaginal repair - Anterior and Posterior
Vaginal Hysterectomy
Marshall Marchetti / Clip pubic hair only.
Check medical officer's preference.
Check medical officer's preference
Prepare area from umbilicus to the upper level of the thighs include genitalia and perineal region
Prepare area from umbilicus to the upper level of the thighs include genitalia and perineal region
Prepare area from umbilicus to the upper level of the thighs include genitalia and perineal region / No preparation
No preparation
No preparation
No preparation
No preparation
No preparation
No preparation
No preparation
No preparation
As above
As above
Abdominal Hysterectomy
Abdominal Tubal Ligation
Caesarean Section
Ectopic Gestation
Oophorectomy
Ovarian Cystectomy
Ovarian Cyst Rupture
Salpingectomy
Tubal Re-anastomosis
Ventrosuspension / Prepare area from level just below the breasts, bed-line to bed-line, to the upper thigh. No visible hair when legs are together. /
NEUROSURGERY
Anterior Cervical Procedures
Craniotomy/Posterior Cervical Procedures
Cloward's Cervical Fusion / Check medical officer's preference.
Preparation attended in the Operating Room.
Prepare area from the lobes of both ears to the shoulders including both axillae.
Alert: Female patients - do not prepare neck.
The graft site is prepared from the waist to mid-thigh and laterally from the bed-line to bed-line. (The immediate pubic area is excluded). The medical officer may indicate which iliac crest is to be used. Prepare from midline to bed-line on that side. / No preparation
ORTHOPAEDICS
Spinal Fusion
Lumbar Laminectomy / Prepare area from the level of the axillae downward to upper thigh, bed-line to bed-line. No through clip required. /
Hand and Wrist Operations
Finger Injuries
Release of Carpal Tunnel / Clean fingernails. The clipped area extends from fingers (if hairy) to elbow, round the whole circumference of the arm.
Alert:Do not clip female patient’s hand or arm /
Elbow Operations
Tennis Elbow Correction
Open Reduction of Olecranon Process. / Prepare area from the wrist to the top of the upper arm (not axilla) around the whole circumference of the arm. /
Knee Operations
Meniscectomy
Total Knee Replacement
Knee Reconstruction
Patellectomy / Prepare area from mid-thigh to mid-calf around the whole circumference of the leg. /
Foot Operations
Keller's Operation
Silastic Implant to Toes
Total Ankle Replacement / Prepare area from the toes to the mid-calf around the whole circumference of the calf and foot.
Clean toe nails /
Hip Surgery (Unilateral)
Austin Moore Prosthesis
Total Hip Replacement
Innominate Osteotomy
Internal Fixation of # Neck of Femur / Prepare area from waist to ankle including the whole circumference of the leg on the affected side. A through clip including peri-anal is required /
Shoulder Operations
Putti Platt
Total Shoulder Replacement / Prepare area from neck to waist and to the midline both anteriorly and posteriorly. The affected shoulder, axilla and circumference of the arm to the wrist are included. /
Iliac Crest Operations
Donor Site for Bone Graft / Prepare area from the waist to the top of the thighs both anteriorly and posteriorly excluding the immediate pubic area. /
PLASTICS
Skin Graft Donor Sites:
Thigh
Upper or Lower Limb
Face and Scalp
Bat Ears / Alert: Obtain specific orders from medical officer before commencing site preparation.
General guidelines only included here:
Circumferential clip from groin to knee. No pubic clip required.
Clean finger or toe nails. Do not clip unless specifically ordered.
Alert: NEVER clip or shave eyebrows. Long hair to be plaited and centred on crown of head. /
THORACIC
Thoracotomy
Lobectomy
Pneumonectomy
Bronchoscopy
Oesophagoscopy / Prepare area from 2/3 of back around affected side to 2/3 of front.
Neck to umbilicus; include underarm and axilla to mid-forearm clip on affected side. /
No preparation
No preparation
Pacemaker Implantation / The prepared area includes a 18cm x 18cm square over the area. Check with the medical officer. Female patients may not require clipping /
Mediastinoscopy / Prepare area from mid-neck, bed-line to bed-line, under chin and downward in an arc from shoulder tip to shoulder tip. Prep down to nipple line. /
THORACIC-ABDOMINAL
Excision Hydatid Cyst.
Thoraco-Abdominal Gastrectomy.
Hepatectomy.
Oesophagectomy.
Ruptured Diaphragm.
Ruptured Liver.
Hiatus Hernia - Thoracic approach. / Prepare area from neck to mid-thigh at the front, 2/3 of affected side including the affected axilla and arm to the elbow. The back area extends from neck to upper third of buttocks, 2/3 of affected side including the arm to the elbow.
No through clip required. Clip visible pubic hair only /
UROLOGY / NEPHROLOGY
Ureters
Re-implantation of Ureter.
Partial or Total Cystectomy / Prepare area from the nipple. A through shave is not required. Clip visible pubic hair only. /
Kidneys
Nephrectomy
Nephropexy
Nephro-ureterectomy
Percutaneous Nephrolithotomy (PCNL) / Prepare area from nipple to groin. Laterally it covers the circumference of the torso excluding the buttocks. /
Scrotum, Testes Prostate
Trans Urethral Resection of Prostrate
Prostatectomy (Open)
Orchidopexy
Varicocele
Hydrocele
Ligation of Spermatic Vein
Ultrasonic Lithotomy / Prepare area from umbilicus to mid-thigh, bed-line to bed-line, including through clip.
Peri-anal clip not required.
Prepare area from umbilicus to mid-thigh, bed-line to bed-line, including through clip.
Prepare area from umbilicus to mid-thigh, bed-line to bed-line, including through clip.
Prepare area from umbilicus to mid-thigh, bed-line to bed-line, including through clip.
Prepare area from umbilicus to mid-thigh, bed-line to bed-line, including through clip. /
As above
As above
As above
Bladder and Prostate
Includes all bladder or prostate operationsexcept Trans Urethral Resection of Prostate / Prepare area from waist to symphysis pubis, bed-line to bed-line. No through clip required. /
Urethroplasty / Clip hair to 1/4 on scrotum and penis, shorter on pubic area. The area extends from umbilicus to upper thigh, bed-line to bed-line.
Alert:Check with the medical officer regarding full or half presentation /
Loin Lesion / Prepare area from midline of back to bed-line, from below axilla to mid-buttocks. /
VASCULAR
Leg Amputation
Below Knee Amputation / Prepare area from mid-thigh to ankle on affected leg, front and back. /
Above Knee Amputation / Prepare area anteriorly from the iliac crest to mid-calf on the affected side. Posteriorly clip from below buttock to mid-calf on the affected side. A full pubic clip is required. /
Aortic and Iliac Endarterectomy / Prepare area from the nipples to the ankles, bed-line to bed-line. No visible hair when legs together. /
Aortic Aneurysm
Oesophagectomy
Pulmonary Embolectomy / Prepare area from the chin to the groin and laterally from bed-line to bed-line including the axilla and top of upper arms. /
Popliteal Endarterectomy / Obtain specific orders from the medical officer
Doc Number / Version / Issued / Review Date / Area Responsible / Page
CHHS17/311 / 1.0 / 03/01/2018 / 01/01/2023 / SOH / 1 of 21
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register