Ab or vag prep first?

We do the vag prep first. Our reasoning is that you risk some splash and or overlap when you do the prep. By doing the vag prep first, you are sure that the abdominal prep area is not contaminated.

Abdominal first then down to the vag prep. Make more sense to prep the clean area then down to the so-called "dirty" area. Just a matter of preference. Mike

Always has been clean to dirty for me also............abdomen, then vag.

Ditto. That's what we were all taught---clean to dirty.

Truthfully--these days everybody gets antibiotic coverage anyway. If your infection rate is low in your operating room, it probably doesn't matter one way or the other.

I put the Foley in once the lady partsl prep is completed; that is, as the last step in the lady partsl prep---that way I save myself the steps I would have taken with Betadine soaked cotton balls, had I put the Foley in before the prep. I hate wasted motion.

Please see AORN Recommended Practices for Skin Preparation of Patients: Recommended Practice V. "1. When preparing the skin for a surgical procedure, special considerations should include - Preparing areas of high microbial counts (eg. umbilicus, pubis , open wounds) within the prepared areas last:"

BL

Clean to 'dirty' is how our facility does it.

I have also always lived with "clean to dirty" for the last 25 years that I've been in the OR. (long shift ! ) :chuckle

But seriously folks.........if you live by the clean to dirty saying, it should be abdomen, then lady partsl.

After finishing the abd prep, I cover it with a sterile towel, to protect it from splashing, ask anyone that has seen me prep, it can get messy!

I then do the lady partsl prep and insert the foley.

That's when the pt is in lithotomy.

If supine, I do the vag prep first, foley,,,, all from a different prep set, put the legs down, blankets, leg strap, bovie ground pad, then with new gloves do the abd. prep.

Other nurses in my hospital do it all pretty much the same, we have not had any real problems that I know of.

Mike

Thanks for all the posts. I still don't know which I prefer better. I think I will go over the recommended practices and go from there. My preceptor says do what feels more comfortable but I would like to do what is best for the patient.

Thanks again everyone

Julie

It's funny, cause I just read this somewhere on AORN's website. They recommended that the abdomen be done first, then the vag prep, then the cath, if needed. The reasoning for this being 1) splashage and 2) being able to manipulate the bladder for catheterization if the need be. They also "no-no'd" something that is sometimes done in our OR, which is at times when there is a second circulator "floating", they at times do the abdominal prep at the same time the other circ is doing the vag prep. They also said there is to be two separate prep setups and two separate glovings. One nurse in particular here has argued doing the cath before the vag prep, but just like AORN questioned, why?

Does it matter what you do first? I was told to do whatever I felt more comfortable with. I was just wondering what everyone elses opinion was.

Julie

Yes, according to an article in the July, 2005 Journal, the perineal prep should be done first, abdomen last, and not done simultaneously. This is contrary to what our practice has been based on AORN standards- clean to dirty. We have questioned AORN and are waiting for their response.

Sandy

Just because AORN says it's so, doesn't mean it is. I read the same article and I don't agree with it. Yes, I do have a problem with authority.

The Association of Operating Room Nurses guidelines say that it is best to work from clean to dirty. If you have to do the vag prep first then you must use a seperate prep and change gloves. You should change gloves before you put in the foley also. Just be careful and don't go back over your prepped area. A large majority of patients are getting an antibiotic before surgery anyway but you really should not let that prevent you from doing a good prep.