Patient preparation

Patients who have been inpatients in hospital for a significant period prior to surgery tend to develop a skin contamination of 'hospital-acquired' organisms. These bacteria tend to be highly resistant to commonly used antibiotics. In such patients, bacterial scrub the night before surgery may be beneficial, although this is unproven.

Any patient harbouring an infection at a site distant to the operation wound has a significantly increased risk of wound sepsis, perhaps doubling the incidence. Therefore any patient with an infected lesion should have this treated before surgery is contemplated.

Shaving the skin in the area of the operation on the night before surgery has now been shown to increase wound sepsis rates. Tiny nicks in the skin acquire bacterial contamination, which is at a much higher level than in the unshaven skin. Hair removal by clipper is advised, or it should not be done at all. Certainly, if shaving is to be performed, this should be done in the anaesthetic area immediately before surgery is about to take place.

Various skin preparation agents for 'sterilising' the skin in the operation field are available, the most commonly used being chlorhexidine and povidone-iodine. A double wash is traditionally performed and the operation area is covered with sterile drapes leaving only a window for surgery. However, it is not possible to sterilise skin completely by the use of such agents.

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