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
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.
- ▪ 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.
- ▪ 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
- ▪ 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
- ▪ The operator should prepare for a procedure depending on
the degree of risk to self and ...