Intraoperative Risk Factors

Surgical Site Preparation

Important to consider the best surgical site preparation routine:

  • hair removal
  • preoperative and intraoperative skin preparation solutions
  • sterile draping

Preparation is extended well beyond the surgical margins to ensure that the areas surrounding the incisions are properly sterilized.

Iodine, alcohol, and chlorhexidine based preparations have been shown to reduce bacterial burden at various surgical sites.

Awareness of the recommended skin preparation solution based on anatomic location of surgery is warranted due to local microbiome and skin flora (ie: shoulder area higher bacterial burden of Cutibacterium acnes which chlorhexidine solution is recommended.)

Surgeon Tools/Recommendations

Hair Removal:

  • Remove hair with a dedicated clipping device with a prepackaged razor in the preoperative area the same day as surgery before entrance into the sterile operating room setting.
  • Proper disposal of the razor after each patient is advised

Preoperative/Preadmission Skin Preparation:

  • Recommend patient perform specific cleanses of surgical site while at home the day before and morning of surgery.
    • Includes shower with chlorhexidine solution or using wipes at home.
  • On the day of surgery, gently wipe the skin with either an alcohol or chlorhexidine based solution (i.e. 70% isopropyl alcohol, chlorhexidine gluconate) in the preoperative area or in the operating room to provide a preliminary cleanse of the entire surgical field.
  • Consider the fire risk associated with isopropyl alcohol in the operating room.
    • May be required to isolate surgical field with clear drapes to ensure that the alcohol-based solutions do not saturate cloth or fabric to reduce the risk of fire.
  • Allow optimal drying time for specific initial preparatory solution to maximize adhesion and technique or proper sterile draping.

Intraoperative Skin Preparation:

  • Iodine, alcohol, and chlorhexidine based solutions are used after the surgical site has been appropriately isolated, marked and the team has appropriate visualization and working area to successfully complete the procedure.
  • Allow each of the skin preparation solutions adequate time to dry
    • Follow manufacture’s recommendations for drying time.
  • Be aware that some surgical skin preparation solutions have been shown to have a greater propensity for erasing surgical markings than others.

Sterile Draping:

  • Once the solution of choice is dry, drape the sterile field.
  • Often, surgeons will choose to use iodine impregnated sticky drapes or incise drapes either along the edges of the sterile drapes or over the entire surgical field.

Evidence shows that iodine impregnated sticky drapes adhere better to certain skin preparation solutions than others.