The following cleaning routine should be adopted to minimise the risk of cross contamination to orthopaedic surgical cases. Patient skin preparation includes 3 stages:
Clipping:
It is vital that clipping is carried out in a separate preparation area away from the operating theatre. Personnel should wear disposable aprons or have an alternative scrub top available for entering theatre.
- Make sure the clippers are ready for use. Remove the blades & dislodge any hairs with a toothbrush. Clean both the blade & clippers using a cloth impregnated with 4% chlorhexidine. Use clipper spray whilst replacing the cleaned blades.
- Confirm the surgical site (to include side of body if applicable) and the area to be clipped verbally with the surgeon.
- Clip the fur away from the surgical site first in the direction of hair growth and then in the opposite direction (this ensures a close clip but decreases the incidence of skin irritation or ‘clipper rash’). The clippers should not be angled against the skin nor be used in an inverted position. Clip carefully to prevent skin scratching or abrasion. NB: Unless the foot is to be operated on it should not be routinely clipped.
- Once clipping is complete, vacuum the patient to remove any loose hair from the clipped site and the area surrounding the patient. Use a lint roller to remove any remaining hair.
Skin preparation:
Personnel should wear non-sterile surgical gloves.
- If the patient is to undergo limb surgery, the distal portion of the limb is bandaged to include the foot, wrapping proximally to the level of the hock or carpus (in the majority of patients).
- Prepare a scrub solution of warm 50:50 water / 4% Chlorhexadine solution in a clean kidney dish.
- Using lint free surgical swabs (no need to be sterile) scrub the surgical site with a methodical back and forth motion starting at the incision site and moving towards the edge of the clip. Use a new swab each time you reach the edge of the clip.
- Repeat for a minimum of 4 times or until the swab is clean after use and the required antiseptic contact time of 3 to 5 minutes has been achieved.
- Once the initial scrub is complete the Rata veterinary surgeon/nurse will administer nerve blocks should these be deemed necessary. Please apply surgical spirit to the areas of needle insertion as indicated by the surgeon/nurse.
- The patient is then ready to be taken into theatre. Ensure that there are enough personnel to transport the patient with minimal handling of the surgical area.
Final skin antisepsis:
This is carried out using a sterile, single use applicator containing a solution of 2% chlorhexidine gluconate and 70% isopropyl alcohol under sterile conditions. This can either be completed by a theatre nurse or scrubbed personnel:
- Remove the applicator from the sterile wrapper and hold the sponge facing downwards.
- Squeeze the applicator gently to break the ampoule containing the antiseptic solution, which releases it onto the sponge in a controlled flow (the broken ampoule remains safely contained within the applicator).
- At the incision site, press the sponge gently against the patient’s skin once and hold for a few seconds until the solution soaks the sponge.
- Lift the applicator and then apply using repeated up and down, back and forth strokes for at least 30 seconds over the incision site and then work outwards to the periphery.
- Discard the applicator into the clinical waste bin after a single use. Leave the area to air dry completely before applying sterile drapes. Do not blot or wipe away.
Please see these videos on how to apply the final skin preparation solution How to videos | Invicta Animal Health (invictavet.co.uk)
