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Which skin preparation technique is most effective to minimise bacterial contamination?

02 April 2019
10 mins read
Volume 10 · Issue 3



The risk of surgical site infections (SSI) can be addressed by removing organic matter which contains transient and resident flora from the patient's skin prior to surgical incision. Using correct techniques when applying skin preparation solution can significantly reduce bacterial load. Historically the circular technique has been used within veterinary practice for skin preparation prior to surgery; however there has been a recent promotion within the veterinary industry using the back-and-forth technique which has historically been used in human medicine.


The move towards evidence-based medicine suggested testing both skin preparation techniques to determine if either technique was more effective than the other at reducing bacterial load.


Five felines undergoing flank ovariohysterectomy surgery were randomly selected for each skin preparation technique with a total sample size of ten felines. Samples of bacterial load were taken before and after the skin was prepared using each technique and cultured in sealed agar plates at a temperature of 38.5°C for 48 hours. Bacterial colonies were then counted and compared pre and post skin preparation. Statistical analysis was performed using ‘Minitab’.


There was no statistically significant difference between either skin preparation technique at reducing the number of colony forming units (Mann-Whitney U test: W=27.0, N=5, p=1.000).


The limited sample size indicated that either technique was as beneficial as the other at preparing the skin for surgery, giving the veterinary nurse confidence in choosing either technique for skin preparation for flank ovariohysterectomy.

Within human and veterinary surgery, pre-paring the surgical site for incision in-volves removing the maximum amount of organic matter, as well as transient and resident flora. This can be achieved through using correct scrubbing techniques (Bowers, 2012).

Historically, veterinary nurses have used the circular scrub technique, also known as ‘target’ or ‘bullseye’ (Swales and Cogan, 2017; Mann, 2018). This uses circular motions starting with the point of incision and working outwards, moving bacteria to the periphery (Mangram et al, 1999; Bowers, 2012). However, the back-and-forth technique has recently been adopted by some veterinary practices due to its popularity in human medicine (McMillan, 2014). The back-and-forth skin preparation technique starts at the incision site and works outwards to the periphery in an up and down motion (Roberts, 2013) and uses friction as well as pressure (Stonecypher, 2009), allowing the first five dermal layers of the skin to be penetrated where most bacteria reside (Stonecypher, 2009). With both techniques, the applicator is disposed of each time it completes a clean of the surgical site and repeated for either a set amount of time or until the applicator comes away clean (Swales and Cogan, 2017).

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