Preoperative Skin Preparation: Soap Selection Guidelines
For preoperative skin preparation, antimicrobial soap (such as chlorhexidine gluconate) is recommended over plain soap for surgical hand antisepsis and patient skin preparation. 1, 2
Surgical Hand Antisepsis Options
Antimicrobial Soap Method
- Remove rings, watches, and bracelets before beginning 1
- Clean underneath fingernails using a nail cleaner under running water 1
- Apply antimicrobial soap and scrub hands and forearms for manufacturer-recommended time (usually 2-6 minutes) 1
- Pay special attention to nails, cuticles, and interdigital spaces 2
- Rinse thoroughly with water 1, 2
- Dry completely with sterile towel 2
Alcohol-Based Hand Rub Method
- First prewash hands and forearms with non-antimicrobial soap 1
- Dry hands and forearms completely 1
- Apply alcohol-based surgical hand-scrub product with persistent activity per manufacturer's instructions 1
- Allow hands and forearms to dry thoroughly before donning sterile gloves 1
Patient Preoperative Skin Preparation
- Apply chlorhexidine gluconate liberally to surgical site 2
- Swab for at least 2 minutes 2
- Dry with a sterile towel 2
- Repeat procedure for an additional 2 minutes 2
- Dry with a sterile towel 2
SOAP Documentation Format Example for Preoperative Skin Preparation
Subjective
- Patient scheduled for [specific surgical procedure]
- No known allergies to chlorhexidine or other antiseptic agents
- No previous adverse reactions to skin preparation products
Objective
- Surgical site identified and marked
- Skin intact with no visible lesions, rashes, or infections
- Preoperative vital signs stable
Assessment
- Patient ready for preoperative skin preparation
- No contraindications to standard antiseptic protocol
Plan
- Perform surgical hand antisepsis using chlorhexidine gluconate antimicrobial soap for 2-6 minutes
- Prepare patient's skin with chlorhexidine gluconate applied for two consecutive 2-minute applications
- Document completion of skin preparation according to protocol
- Proceed with sterile draping and surgical procedure
Important Considerations
Product Selection
- Provide personnel with efficacious hand-hygiene products with low irritancy potential 1
- Consider product compatibility with gloves and other skin care products 1
- Do not add soap to partially empty dispensers ("topping off") as this can lead to bacterial contamination 1
Technique Specifics
- When using soap and water, wet hands first with water 1
- Apply manufacturer-recommended amount of product 1
- Rub hands vigorously for at least 15 seconds, covering all surfaces 1
- Avoid hot water as it increases risk of dermatitis 1
- Use disposable towels rather than multiple-use cloth towels 1
Skin Care
- Provide hand lotions or creams to minimize irritant contact dermatitis 1
- Non-petroleum based lotions are preferred as petroleum can deteriorate latex gloves 1
Common Pitfalls to Avoid
- Inadequate scrub time (less than manufacturer recommendations)
- Insufficient attention to nails, cuticles, and interdigital spaces
- Failure to completely dry hands before donning gloves
- Using hot water which can increase skin irritation 1
- Wearing artificial fingernails or extenders, which harbor microorganisms 1
By following these evidence-based guidelines for preoperative skin preparation, healthcare providers can significantly reduce the risk of surgical site infections and improve patient outcomes.