Obtaining thorough mechanical cleansing of the skin at the proposed operative site should be the goal. Depending on the hygienic state of the patient, and the nature of the injury, this goal may be attained easily or may require a fair amount of focused attention. When prepping about the face, avoid using solutions that are irritating to the eye. Prep at least 2 inches beyond all the skin which will be exposed after draping. In the face and neck area, prep the entire face and anterior neck, so that they may be left exposed. This arrangement is more comfortable for the patient and is particularly important when nasal oxygen is being used. Leaving the face and neck open, prevents the pooling of oxygen under the drapes and thus greatly decreases the risk of an explosion or fire. Any nasal oxygen should obviously be turned off before using the cautery. As noted previously, hairy abraded areas, except the eyebrows, should be shaved. The eyebrows, even if abraded, should not be shaved because one needs the hair pattern to secure proper alignment, assuming they are lacerated. The old tale that eyebrows will not grow back if shaved is obviously hogwash.

Avoid getting prep solutions in the wound as much as possible. The only time the wound itself should be prepped is when it is going to be completely excised, such as a pressure ulcer. Avoid using alcohol or 3% hydrogen peroxide on wounds. These solutions are protoplasmic poisons. As noted previously, ½% hydrogen peroxide is helpful as a preoperative mouthwash when dealing with lip or oral defects.

Thorough prepping is especially important on the scalp, about the ears and in the axilla, groin and umbilicus. Be sure that sebaceous material and other detritus has been removed.  Usually the nurses do a good job prepping but in the critical areas referenced above, one needs to be certain that the skin is mechanically clean. At times, the prepping routine can be more form than substance, particularly with the less experienced. Just because the skin involved has been painted with an antiseptic solution doesn’t mean that the prep has been adequate.

When prepping awake patients, it is important to use warm solutions. This step is particularly applicable with pediatric patients or more sensitive adults. Any excess prep solution should be wiped away.

In the emergency room, trauma bay and at the bedside I routinely do my own prepping.

Keeping the drapes in place and some areas can be challenging. A little creativity in the placing of towel clips and hemostats as counterweights can often be helpful in these circumstances.