The purpose of skin preparation before surgery is to:
• Remove dirt and transient flora
• Reduce the resident flora
• Inhibit rapid regrowth of bacteria on the skin [ 3 ].
Clipping the surgical site
Clipping the surgical site is an essential step when preparing the patient for surgery. Removing the patient ' s fur around the surgical site will remove some dirt, debris and bacteria.
For most surgical procedures, an area 15 – 20 cm wide is clipped around the proposed incision site [ 4 ], and for smaller dogs an area of 10 – 15 cm. For an exlap, the patient ' s abdomen should be clipped from approximately 5 cm above the xiphoid process to the pubic symphysis. Laterally, the edge of the clipped area should be the same distance from the nipple line as the midline is( Figure 1).
Non-sterile gloves and a waterproof apron should be worn while clipping, to reduce the risk of contamination. The gloves should be changed once all the hair has been removed [ 5 ].
A good clipping technique( see Box 1) is vital to reduce the risk of clipper rash, as this can increase the risk of SSIs; it can also be uncomfortable for the patient and might lead the patient to cause self-trauma [ 5 ].
Box 1
Good clipping technique
• Use appropriately sized clippers
• Keep the clipper blades flat on the skin
• Apply the correct amount of pressure
• Clip in the direction of the hair growth and then against it to get the closest clip possible
• Regularly check the temperature of the clipper blades, as hot blades can cause burns
• Good clipper maintenance includes changing the blades regularly, and thorough cleaning and oiling of the blades [ 5 ]
When clipping the patient, it is also important to check for any skin problems, such as pustules, which may indicate a skin infection and will increase the risk of an SSI. In some cases where surgery is an emergency, such as with ex-laps, this may not affect whether the surgery goes ahead, but it is still important to note.
Surgical skin preparation
Once the fur has been removed from the surgical site and the table has been cleaned, the next step is to put on clean gloves and prepare the patient ' s skin. It is important to select an agent that will effectively remove dirt and bacteria and prevent the rapid regrowth of the resident flora; an example is chlorhexidine scrub diluted 1:1 with water. An alternative product, which may be more appropriate in some situations, is povidone-iodine; however, it is not as effective as chlorhexidine when preparing the skin due to some of its properties( Table 3, page 53).
Figure 1. Area to be clipped for an exploratory laparotomy.
The diluted agent should be applied to the skin on a lint-free swab, starting from the incision site and working outwards towards the edges of the clipped area [ 6 ]. It is important to discard the swab once the outside edges have been reached, to prevent bacteria or dirt from being returned to the incision site.
52 Veterinary Nursing Journal