Advertisement

Fundamentals of Patient Positioning and Skin Prep

  • Giulio Giambartolomei
  • Samuel Szomstein
  • Raul Rosenthal
  • Emanuele Lo Menzo
Chapter

Abstract

Proper patient positioning is of paramount importance for the completion of a safe and successful operation. The technological advances in the operating room have significantly increased the safety for both patients and healthcare providers. However, the ever-growing volume of cases and their complexity require increase focus on patient care in the operating room (OR).

Patient positioning is a key element of safety in the OR. Particular attention should be paid to the prevention of neural injuries, falls, pressure ulcers, and ocular damages.

Another key element for the success of any surgical intervention is the skin preparation. The correct use of the potent antiseptic solution can decrease the bacterial contamination to a minimum. However, thorough knowledge of such solutions is paramount in order to take full advantage of their effectiveness and to avoid potentially serious complications.

In this chapter, we described the principles of OR safety as it relates to the positioning of the patient and the skin preparation.

Keywords

Operating room safety Patient positioning Skin preparation 

Suggested Readings

  1. Warner MA. Perioperative neuropathies. Mayo Clin Proc. 1998;73(6):567–74.CrossRefPubMedGoogle Scholar
  2. O’Connell MP. Positioning impact on the surgical patient. Nurs Clin North Am. 2006;41(2):173–92, vCrossRefPubMedGoogle Scholar
  3. Dumville JC, McFarlane E, Edwards P, Lipp A, Holmes A, Liu Z. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev. 2015;4:CD003949.Google Scholar
  4. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infection control and hospital epidemiology. 1999;20(4):250–78; quiz 79–80.CrossRefGoogle Scholar

References

  1. 1.
    Manfredini M, Ferrante R, Gildone A, Massari L. Unilateral blindness as a complication of intraoperative positioning for cervical spinal surgery. J Spinal Disord. 2000;13(3):271–2.CrossRefPubMedGoogle Scholar
  2. 2.
    Cheney FW, Domino KB, Caplan RA, Posner KL. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology. 1999;90(4):1062–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Warner MA. Perioperative neuropathies. Mayo Clin Proc. 1998;73(6):567–74.CrossRefPubMedGoogle Scholar
  4. 4.
    Warner MA, Warner ME, Martin JT. Ulnar neuropathy. Incidence, outcome, and risk factors in sedated or anesthetized patients. Anesthesiology. 1994;81(6):1332–40.CrossRefPubMedGoogle Scholar
  5. 5.
    O’Connell MP. Positioning impact on the surgical patient. Nurs Clin North Am. 2006;41(2):173–92.CrossRefPubMedGoogle Scholar
  6. 6.
    King CA, Bridges E. Comparison of pressure relief properties of operating room surfaces. Perioper Nurs Clin. 2006;1(3):261–5.CrossRefGoogle Scholar
  7. 7.
    Primiano M, Friend M, McClure C, et al. Pressure ulcer prevalence and risk factors during prolonged surgical procedures. AORN J. 2011;94(6):555–66.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Slater MS, Mullins RJ. Rhabdomyolysis and myoglobinuric renal failure in trauma and surgical patients: a review. J Am Coll Surg. 1998;186(6):693–716.CrossRefPubMedGoogle Scholar
  9. 9.
    Furnas H, Canales F, Buncke GM, Rosen JM. Complications with the use of an axillary roll. Ann Plast Surg. 1990;25(3):208–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Graling PR, Colvin DB. The lithotomy position in colon surgery. AORN J. 1992;55(4):1029–39.CrossRefPubMedGoogle Scholar
  11. 11.
    Global guidelines for the prevention of surgical site infection. Geneva: World Health Organization; 2016. Available from: https://www.ncbi.nlm.nih.gov/books/NBK401132/.
  12. 12.
    Chlebicki MP, Safdar N, O’Horo JC, Maki DG. Preoperative chlorhexidine shower or bath for prevention of surgical site infection: a meta-analysis. Am J Infect Control. 2013;41(2):167–73.CrossRefPubMedGoogle Scholar
  13. 13.
    Paulson DS. Efficacy evaluation of a 4% chlorhexidine gluconate as a full-body shower wash. Am J Infect Control. 1993;21(4):205–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Byrne DJ, Napier A, Cuschieri A. Rationalizing whole body disinfection. J Hosp Infect. 1990;15(2):183–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011; (11):Cd004122.Google Scholar
  16. 16.
    Dumville JC, McFarlane E, Edwards P, Lipp A, Holmes A, Liu Z. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev. 2015; (4):CD003949.Google Scholar
  17. 17.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infection control and hospital epidemiology 1999; 20(4): 250–78; quiz 79–80.CrossRefGoogle Scholar
  18. 18.
    Girard NJ. Standards, recommended practices, and guidelines. AORN J. 2006;83(2):307–8.CrossRefPubMedGoogle Scholar
  19. 19.
    WHO guidelines for safe surgery: 2009: safe surgery saves lives. ISBN 978 92 4 159855 2 (NLM classification: WO 178) © World Health Organization. 2009.Google Scholar
  20. 20.
    Vo A, Bengezi O. Third-degree burns caused by ignition of chlorhexidine: a case report and systematic review of the literature. Plast Surg (Oakville, ON). 2014;22(4):264–6.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Giulio Giambartolomei
    • 1
  • Samuel Szomstein
    • 1
  • Raul Rosenthal
    • 1
  • Emanuele Lo Menzo
    • 1
  1. 1.Department of SurgeryThe Bariatric and Metabolic Institute, Cleveland Clinic FloridaWestonUSA

Personalised recommendations