How should you prep an infected/dirty operative site?

[malicexmirage]

So I'm a newbie in the operating room (1 yr in training) and I've come across times where I have to prep a dirty/infected surgical site. I know we have to prep from clean to dirty and from the incision site and outwards and never come back. I'd appreciate some clarifications on this as I have mixed feelings about it.. I just have this thought that if I do that with an infected site, I'm spreading it more towards the lesser dirty/infected areas.

Just like recently where I had to prep a toe due for amputation (pt has MRSA, surgical site infected with osteomyelitis w/ 5mm diameterx3-4mm depth ulceration),my orientator told me to prep from the surgical site and away, so I prepped from the infected toe,around the foot (which I feel iffy bcoz foot is also dirty) and the rest of the leg upward. It's really discombobulating about how should I prep these types of things.

Also, another case I had was prepping a site for vascular case where incision site is on the groin. As usual you start from the incision site and away from it, so I did that according to my orientator (As she showed me how,I started from the groin,circular motions, as I don't feel right prepping the surroundings of the groin since it's the perineum w/c is usually last).

I feel bummed due to lack of material/feasible resources and the place I work with hasn't even made me take PeriOp101 Yet! (so i'm planning to take it out-of-pocket if they don't provide it to me). Can anyone enlighten me on this?

I appreciate any help!

[Rose_Queen, BSN, MSN, RN]

You can always get new prep sticks- that's what I do. Recent ostomy takedown, the surgeon held a sponge over the ostomy itself (surgical site) to contain the secretions while I prepped the remainder of the area. Then we got new prep sticks and prepped the ostomy itself. With infected surgical wounds that are the surgical site, I'll prep those first, dispose of the prep stick, and get new prep sticks for the remainder.

[Mr. & Mrs. RN]

For an open infected toe, I would put a paint sponge on the dirty spot and prep from the foot up the leg. It also serves as a great way to lift the leg while prepping. Then prep the dirty spot last. All of my foot preps I prep from surgical site out, regardless of clean to dirty. For the groin surgery, you can prep the groin first with a separate stick, then prep the clean area with a new stick. If you're ever unsure, use new sponges and new gloves.

[hereinlc]

As a reference, I find this helpful:

http://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/Standard_Skin_Prep.pdf