What is skin preparation (skin prep)?

Skin Preparation: A Critical Infection Prevention Technique

Skin preparation (skin prep) is a systematic cleaning and disinfection of the skin surface using antiseptic agents to reduce microbial burden before invasive procedures, which significantly reduces the risk of infection-related morbidity and mortality. 1

Components of Skin Preparation

Standard Skin Prep Protocol

• Locate and palpate the procedure site prior to beginning skin preparation 1
• Wash the site using antibacterial soap or scrub (e.g., 2% chlorhexidine) and water 1
• Apply antiseptic solution using a circular rubbing motion 1
• Common antiseptic agents include:
  • 70% alcohol (requires 1-minute application time) 1
  • 10% povidone-iodine (requires 2-3 minutes to dry completely) 1
  • Chlorhexidine-alcohol combinations (most effective for surgical site infection prevention) 2

Proper Application Technique

• Apply antiseptic in a circular motion starting from the procedure site and moving outward 1
• Allow adequate contact time for the antiseptic to achieve full bacteriostatic effect 1
• Ensure the antiseptic solution dries completely before proceeding with the procedure 1
• Use clean gloves during the procedure and change if contaminated 1

Antiseptic Agent Selection

Alcohol-Based Preparations

• Provide rapid bactericidal action but have short duration 1
• Must be applied for at least 1 minute in a rubbing motion 1
• Most effective when combined with other antiseptics like chlorhexidine 2

Povidone-Iodine Preparations

• Require 2-3 minutes to achieve full bacteriostatic effect 1
• Must dry completely before proceeding with the procedure 1
• FDA-approved for reducing bacteria that potentially cause skin infections 3

Chlorhexidine-Based Preparations

• Chlorhexidine-alcohol combinations rank highest in effectiveness for preventing surgical site infections 2
• Provide longer-lasting antimicrobial activity compared to alcohol alone 4
• May be preferred for procedures with higher infection risk 4

Clinical Applications

Vascular Access Procedures

• For hemodialysis access sites, a clean technique using antiseptic agents is essential 1
• Proper skin prep reduces the risk of bloodstream infections, which significantly increase morbidity and mortality in ESRD patients 1
• Staff must comply with hand hygiene protocols and wear clean gloves during procedures 1

Surgical Procedures

• Surgical skin preparation should be performed with an alcohol-based antiseptic agent unless contraindicated 1
• Patients should shower or bathe with soap or antiseptic before surgery when possible 1
• Paint-only technique with aqueous povidone-iodine is equivalent to scrub-and-paint for abdominal surgeries, potentially reducing operative time 5

Neuraxial Procedures

• For central neuraxial blockade, 0.5% chlorhexidine in alcohol provides the safest compromise between infection risk and neurotoxicity 1
• Application method should minimize the risk of antiseptic contamination of equipment 1

Important Considerations

Infection Prevention

• Proper skin preparation significantly reduces surgical site infections and associated morbidity 1
• Systematic approach including pre-procedure bathing/showering and surgical site preparation provides superior infection prevention 6
• Clean and sterile prep kits show no difference in residual microbial flora, offering potential cost savings 7

Site-Specific Recommendations

• Different anatomical sites may benefit from specific preparation techniques based on local microbial flora 4
• For orthopedic procedures, chlorhexidine-alcohol combinations are generally recommended, with additional site-specific considerations 4

Common Pitfalls to Avoid

• Insufficient drying time before procedure (especially with povidone-iodine) 1
• Contamination of sterile equipment with antiseptic solutions 1
• Inadequate application technique (not using circular motion from center outward) 1
• Failure to allow adequate contact time for full antiseptic effect 1