Preoperative Preparation for Surgical Staff
Surgical staff must follow specific procedures to ensure that surgery is conducted under aseptic conditions.
General Preparation
After entering the operating room, surgical staff change into clean clothing and shoes provided by the operating room and wear a surgical cap and mask. The cap must cover all hair, and the mask must adequately cover the nostrils. Fingernails should be trimmed short, and any debris under the nails should be removed. Individuals with cuts or purulent infections on their hands or arms are not permitted to participate in surgery.
Surgical Hand Antisepsis
The skin surface of the human body harbors microbial communities: some reside in the deeper layers of the skin, such as folds and pores, and are referred to as resident flora; others are transient flora, loosely attached to the skin surface and primarily acquired from the environment. Surgical hand antisepsis aims to remove nearly all transient flora from the skin surface, along with some resident flora. However, resident flora located in deeper layers of the skin may gradually migrate to the surface during surgery. For this reason, sterile gloves and surgical gowns must be worn after hand and arm antisepsis to prevent bacteria from contaminating the surgical wound.
Hand and arm antisepsis involves two steps: cleaning and disinfection. The hands and arms are first thoroughly cleaned using soap or handwash and the "six-step handwashing technique" to remove all visible debris. A disinfectant is then applied to perform antisepsis. Common hand disinfectants include ethanol, isopropanol, chlorhexidine, and povidone-iodine. Methods of disinfection include the scrubbing method, rinsing method, and no-rinse method. The scrubbing method is most commonly used for surgical hand antisepsis and involves scrubbing the hands and forearms for 3 minutes in a specific sequence to meet surgical hand antisepsis standards. The development of newer hand disinfectants has simplified the disinfection process over time.
Donning Sterile Surgical Gowns and Gloves
After completing hand and arm antisepsis, sterile surgical gowns and gloves are donned following aseptic techniques.
Preparation of the Patient’s Surgical Area
The skin of the patient also harbors resident and transient flora. These microorganisms can enter the incised tissue during surgery and potentially cause infections. Preparing the patient’s surgical area aims to eliminate transient flora from the skin at the surgical incision site and surrounding areas and to suppress the migration of resident flora, thereby reducing the risk of surgical site infections.
If dense hair is present near the surgical site and interferes with visibility or operative procedures, it is typically removed prior to surgery. Patients in good health are generally advised to bathe the day before surgery.
For procedures requiring more than local anesthesia, skin disinfection is performed after anesthesia induction. The traditional method of skin disinfection involves applying 2.5%–3% iodine tincture to the surgical area, allowing it to dry, and then wiping it twice with 70% alcohol to remove the iodine tincture. In recent years, specialized skin disinfectants containing active iodine or chlorine have become widely available and are increasingly used in clinical practice.
Disinfection Protocol
Disinfectants should be applied by wiping from the center of the surgical site outward toward the periphery. For surgeries involving infected areas or the perianal region, disinfection should proceed from the periphery toward the infected site or anus. Gauze soaked in disinfectant that has already contacted a contaminated area should not be used again on clean areas.
The disinfected skin area must cover a zone extending 15 cm beyond the surgical incision. If extending the incision is anticipated, a larger area should be disinfected accordingly.
After disinfecting the surgical site, sterile drapes are applied to exclude non-surgical areas, leaving only the minimum amount of skin necessary for the surgical incision exposed. This step minimizes contamination during surgery and provides a sterile surface for surgical procedures. Around the surgical incision, at least four layers of sterile drapes must be applied.
Principles for Draping
Draping begins with areas considered relatively less clean (e.g., the lower abdomen or perineum) and concludes with the area near the operator.
The corners of overlapping drapes should be secured with towel clamps to prevent movement.
Drapes should not be repositioned arbitrarily after placement. If adjustments are needed, movement should be directed outward from the surgical site and never inward toward it.