General Practice Guide for Surgery

Author: Liu Zhisu et al. / Country:
Publisher:
Publishing Time: 2003-04-01
Features:
4. Hair removal is not necessary for pediatric surgical procedures except those on the head.
5. For non-emergency surgeries, if redness, folliculitis, or small boils are found at the skin incision site, the surgery should be postponed to avoid incision infection.
6. Before skin grafting on granulation wounds caused by burns or other lesions, dressing changes are required to minimize infection and reduce exudation.
(II) Skin disinfection of the surgical area
1. Disinfection methods
(1) Check the cleanliness of the skin in the disinfection area.
(2) After hand disinfection (without gloves), use sterile forceps to hold a gauze pad (1 pad soaked in 3% povidone-iodine, 2 pads soaked in 70% alcohol).
(3) First, use the 3% povidone-iodine pad to wipe the surgical area skin, wait for it to dry, and then use the 70% alcohol pad to wipe twice, removing all iodine. The range of each wipe gradually decreases. Finally, use the alcohol pad to clean the iodine from the edges. Since the bactericidal effect of povidone-iodine is due to free iodine released during its sublimation process, which kills bacteria, it also causes significant irritation to the skin. Therefore, after the povidone-iodine dries and gains bactericidal effectiveness, use a 70% alcohol pad in the same manner twice to remove the iodine. This not only leverages the strong bactericidal power of povidone-iodine but also overcomes its skin irritation. The key to the operation is to apply evenly and thoroughly without, and the iodine should be removed only after it dries. In Western and Japanese countries, the povidone-iodine-alcohol disinfection method is rarely used for skin disinfection of the surgical area. Instead, 0.5% povidone-iodine is commonly used, as it has the same bactericidal ability as povidone-iodine but without its skin irritation. When using this agent for disinfection, only two wipes are needed as per the above method, and no removal of iodine is required.
2. Disinfection methods
(1) Circular or spiral disinfection: Used for disinfecting small surgical areas.
(2) Parallel or overlapping tile disinfection: Used for large surgical areas.
3. Disinfection principles
(1) Centrifugal disinfection: For clean incision skin disinfection, start from the center of the surgical area and wipe outward.
(2) Radial disinfection: For infected wounds or disinfection of the perineum and perianal area, start from the clean periphery of the surgical area and wipe toward the wound or perineum/perianal area.
4. Disinfectants used for different surgical sites
Due to differences in patient age and surgical site, the type of disinfectant used for skin disinfection of the surgical area varies.
(1) Skin disinfection for infants and children: Due to their delicate skin, 70% alcohol or 0.75% povidone-iodine is generally used. For surgical areas such as the perineum and face, 0.3% or 0.5% polyiodine is used.
(2) Skin disinfection for neurosurgery, orthopedics, and cardiothoracic surgery: Use 3%-4% povidone-iodine, wait for it to dry, and then use 70% alcohol to remove the iodine.
(3) Skin disinfection for general surgery: Use 3%-4% povidone-iodine, wait for it to dry, and then use 70% alcohol to remove the iodine. Alternatively, use 0.5% polyiodine twice without removal.
(4) Perineal surgery disinfection: Use 0.5% polyiodine twice for the skin and mucosa of the perineum.
(5) Ophthalmology and otolaryngology surgery disinfection: Use 70% alcohol twice for facial skin; use 0.5% polyiodine or 2% mercury bichloride for oral mucosa and nasal mucosa.
(6) Skin grafting donor site disinfection: Use 70% alcohol to wipe 2-3 times.
(7) Disinfection for skin injuries with contamination: For wound cleaning after burn debridement and fresh trauma, use sterile normal saline to rinse repeatedly until the wound is basically clean, then dry. Treat burn wounds according to their depth. For trauma wounds, use 3% hydrogen peroxide and a 1:10 polyiodine dilution solution for soaking disinfection, and disinfect the surrounding skin as per routine. Patients with severe trauma also need to re-disinfect and drape the wound before suture.
5. Disinfection range of the surgical area
(1) Head surgery skin disinfection range: Head and forehead (Figure 3.6A).
(2) Oral and lip surgery skin disinfection range: Lips, neck, and upper chest.
(3) Neck surgery skin disinfection range: Up to the lower lip, down to the nipple, and laterally to the anterior border of the trapezius muscle (Figure 3.6B).
(4) Clavicle surgery skin disinfection range: Upper neck margin, lower to the upper one-third of the arm and upper edge of the nipple, laterally over the midaxillary line.
(5) Chest surgery skin disinfection range: (Lateral position) Front and back over the midline, upper to the clavicle and upper one-third of the arm, lower over the costal margin (Figure 3-6C).
(6) Breast radical surgery skin disinfection range: Front to the midline of the contralateral clavicle, back to the posterior axillary line. Upper to the clavicle and upper arm, lower over the parallel line of the umbilicus. If skin is taken from the thigh, the thigh should extend to the knee, with surrounding disinfection.
(7) Upper abdominal surgery skin disinfection range: Upper to the nipple, lower to the pubic symphysis, and laterally to the midaxillary line (Figure 3.6D).
(8) Lower abdominal surgery skin disinfection range: Upper to the xiphoid process, lower to the upper one-third of the thigh, and laterally to the midaxillary line.
(9) Inguinal and scrotal surgery skin disinfection range: Upper to the umbilical line, lower to the upper one-third of the thigh, and laterally to the midaxillary line (Figure 3-6E).
(10) Cervical surgery skin disinfection range: Upper to the top of the head, lower to the line connecting both axillae.
(11) Thoracic surgery skin disinfection range: Upper to the shoulder, lower to the iliac crest line, and laterally to the midaxillary line.
(12) Lumbar surgery skin disinfection range: Upper to the line connecting both axillae, lower over the buttocks, and laterally to the midaxillary line.
(13) Renal surgery skin disinfection range: Front and back over the midline, upper to the axillae, lower to the inguinal area (Figure 3-6F).
(14) Perineal surgery skin disinfection range: Pubic symphysis, perianal area, and inner side of the upper one-third of the thigh.
(15) Limb surgery skin disinfection range: Surrounding disinfection, extending above and below one joint.
6. Precautions
(1) Areas such as the face, lips, perineal mucosa, and scrotum cannot tolerate the irritation of povidone-iodine. Use disinfectants with less irritation as substitutes. For example, 2% mercury bichloride or 0.5% polyiodine solution can be used, but neither should come into contact with or be mixed with iodine.
(2) When applying various disinfectants, apply with slightly more force to increase penetration.
(3) Clean incisions should be disinfected from the incision center outward; for infected wounds or perineal/perianal surgery, start from the periphery of the surgical area and disinfect toward the wound or area. Disinfectant gauze that has touched the edge of the disinfection range or contaminated areas should not be reused on clean areas.
(4) The disinfection range should include the area around the surgical incision within 15-20 cm, and the range should be expanded if there is a possibility of extending the incision.
(5) When disinfecting abdominal skin, first drip a few drops of disinfectant into the navel, wait for the skin disinfection to complete, and then wipe clean.
(6) Do not soak the povidone-iodine gauze with too much solution to avoid it spreading and irritating burned skin. The removal of iodine must be thorough.