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Introduction

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Preprocedural prepping and draping is essential to sterile performance of a procedure and prevention of device contamination. Proper preparation has been shown to prevent nosocomial infections and has become the subject of consensus recommendations, governmental guidelines, and regulatory review.

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Definitions and Terms

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Skin preparation and site draping prior to performance of a procedure is intended to minimize the likelihood of either a surgical site or nosocomial infection. The goals of skin preparation are to remove soil and transient microorganisms from the skin, reduce microbial counts to subpathogenic levels in a short period of time with minimal tissue irritation, and inhibit rapid regrowth of microorganisms. Consensus guidelines have been developed by the Centre for Disease Control and Prevention (CDC) for skin and site preparation for central venous catheters which can reasonably be extrapolated to central venous devices (ie, intravascular pacing wires), central intra-arterial catheters and devices (ie, intra-aortic balloon pump). Devices at lower risk of infection (ie, peripheral intravenous catheter) can be inserted with less stringent techniques.

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  • ▪  Hand hygiene: See Chapter 4.
  • ▪  No-touch procedure: Performance of a procedure during which the sterile portion of a device is not touched (ie, catheter portion of peripheral intravenous catheter).
  • ▪  Aseptic technique: Includes the use of sterile or nonsterile gloves and a no-touch technique (ie, no contact with the portion of the device that will be inserted).
  • ▪  Skin antisepsis: Depending on site, may include hair removal and skin cleansing with an antibacterial agent including povidone-iodine, chlorhexidine, or alcohol.
  • ▪  Draping: A method by which the sterile area in which a procedure is to be performed is isolated from a potentially contaminated area. Options include paper, cloth, and plastic drapes. Drapes may also be used to lay out equipment used for performance of procedure.
  • ▪  Maximal sterile barrier precautions: Includes cap, mask, sterile gown, sterile gloves, and large sterile drape.

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Techniques

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  • ▪  Nonsterile gloves should be worn to protect healthcare workers during the performance of any procedure in which there is a risk of contact with patient’s blood, fluids, or secretions, and which does not require prep and drape (ie, nasogastric tube placement).
  • ▪  Hand hygiene should be performed prior to and between all procedures as described in Chapter 4.
  • ▪  Procedures that do not violate patient’s defense mechanisms or wherein sterilization is infeasible (ie, cardioversion, endotracheal intubation, feeding tube placement) can be performed without prepping or draping.
  • ▪  Procedures associated with minimal risk of nosocomial infection (ie, peripheral intravenous catheter placement) may be performed following skin antiseptic preparation using a no-touch procedure and without draping.
  • ▪  Procedures in which the skin is violated and that are associated with high risk of nosocomial infections should be performed with maximal sterile barrier precautions including site preparation and draping.
  • ▪  The operator should prepare for a procedure depending on the degree of risk to self and patient according to ...

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