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Preparing and equipping the patient for surgery

Site: EHC | Egyptian Health Council
Course: دلائل الاجراءات التمريضية لقسم العمليات
Book: Preparing and equipping the patient for surgery
Printed by: Guest user
Date: Tuesday, 5 May 2026, 11:38 PM

Description

"last update: 6 March 2025"                                                                                       تحميل الدليل
  

Table of contents

- Prepared by

Operation Room guide

Under supervision

- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council

 Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate

 

Prepared by 

Title  

Name

NO.

Dean Of Faculty Nursing, Professor of Medical and Surgical Nursing, Tanta University

Dr Afaf Abdel Aziz Abdel Aziz Basal

1

Professor Of Critical Care Nursing

Prof.Dr/Zeinab Hussain Ali

2

Professor And Head of the Department of Medical Surgical Nursing. Faculty-. Benha University

Amal Said Taha Refaie

3

Supervisor Of the Education Sector at Port Said University

Amal Ahmed Khalil Morsy

4

Professor Of Medical Surgical Nursing- Faculty of Nursing- Cairo University

Dr. Hanan Ahmed Al Sebaee

5

Head of central administration on secondment at MOHP

Dr Neveen ab drab al0nabi Mohamed

6

Director Of Primary Health Care Nursing Department at MOHP.

Maysa Hosny Ahmed Tammam

7

Supervisor Of Technical Education- EHA 

Nancy Alaa Eldeen Abd-Elbaset Ali

8

Supervisor Of Nursing Services Development- EHA

Sherien Mohamed Saad

9

Assistant Professor of Maternity and Neonatal Health Nursing - Faculty of Nursing- Ain Shams University

Assist.Perof. Dr./Heba Mahmoud Mohammed

10

General manager of general administration of health institutes affairs

Dr Mai Galal Ibrahim Al-Assal

11

Participants  

Head of nursing administration at EHA

Mr. Adham Abdel Nasser Okasha

12

member of the Nursing administration at EHA, luxor branch

Mr. Gehad Akram Hussein

13

- Skin Preparation for Surgery

Skin Preparation for Surgery

Proper skin preparation is crucial to minimize the risk of infection and ensure a sterile surgical field.

Required Equipment:

  • Skin preparation tools
  • Sterile water
  • Sterile gloves
  • Antiseptic skin solution

Steps:

  1. Open the skin preparation equipment and place it on a small table or trolley next to the operating table.
  2. Pour sterile water into the preparation basin, which contains soap, gauze, and sponges.
  3. Pour antiseptic solution into a separate basin, which contains only sponges.
  4. Ask the anesthesiologist for approval before starting the preparation process.
  5. Expose the surgical site by removing or adjusting the patient’s clothing.
    • Confirm the correct surgical site (limb or body part).
  6. Place a sterile drape or dressing above and below the area to be prepared.
  7. Wear sterile gloves.
  8. Prepare two sterile gauze pieces.
  9. Use a sterile sponge to clean the surgical site in a circular motion.
    • Keep one hand in contact with the surgical site throughout the preparation.
  10. Simultaneously, use the other hand to clean the surrounding area with a sponge and soap using a circular motion:
    • Move your hand upward slowly while massaging the skin.
    • Continue this process for 3 minutes.
    • Ensure a large area around the surgical site is prepared.
  11. After cleaning:
    • Dispose of the used sponge.
    • Place a sterile drape over the cleaned area.
    • If one drape is insufficient, request another from the assisting nurse.
  12. Apply an antiseptic solution using sterile forceps or a sterile clamp:
    • Take a sponge soaked in antiseptic.
    • Start from the incision site, moving outward in circular motions.
    • Do not reuse the same sponge on the incision area.
    • Dispose of the used sponge and take a fresh sterile sponge from the preparation basin.
  13. If the surgical site is contaminated (e.g., perianal region or colostomy site):
    • Place a sponge over the anus before cleaning.
    • Begin cleaning from the surrounding area first while keeping a sponge over the contaminated site.
  14. For colostomy cases, disinfect using a stool removal basin before continuing with standard antiseptic procedures.
  15. When using an antiseptic:
    • Place a sponge over the contaminated site (e.g., anus), then proceed with the usual disinfection steps.
    • Ensure the contaminated area is fully disinfected before removing the sponge.
  16. Remove and discard the used drapes or covers after completing the skin preparation.
  17. Clear all preparation equipment and ensure the operating room remains sterile and clean.

  

- Face and Nose Preparation for Surgery

Steps for Face and Nose Preparation:

1. Cover the patient's eyes with a sterile drape or ask the patient to close their eyes if they are awake.

2. Prepare the area surrounding the surgical site, ensuring cleaning extends at least up to the hairline.

3. Use special cotton swabs to clean the inside of the nose if the surgery involves the nasal area.

- Ear preparation for surgery

Ear Preparation:

1. Start cleaning from the ear canal, then move outward to the auricle and tragus.

2. Continue cleaning towards the helix, then the antihelix and earlobe.

3. Ensure thorough cleaning of creases and folds, where dirt accumulates.

4. Do not push the sponge deep inside the ear canal.

5. Do not insert cotton swabs into the ear.

6. Prepare the area behind the ear, including:

  • The entire shaved area
  • The hairline
  • The side of the ear

- Neck preparation for surgery

Steps for Preparing the Neck for Surgery:

1. Remove the patient’s clothing and pull the blanket up to the nipple line.

2. Place a sterile towel or drape over the blanket, then fold it over the non-sterile portion.

Neck Preparation:

  • Extend cleaning from the side of the neck to the edge of the operating table.
  • Move upward to the lower jaw.
  • Cover the area up to the shoulders.
  • Extend downward to the chest, reaching the nipple line.

Additional Preparation for Head and Neck Surgeries:

  • Include the face up to the eyes.
  • Prepare the shaved area of the head (if applicable).
  • Clean both ears.
  • Ensure proper cleaning of the back of the neck.
  • Extend preparation over the shoulders.

- Shoulder preparation for surgery

Steps

  1. The anesthesiologist turns the patient’s head away from the area to be prepared.
  2. Remove the patient’s clothing and adjust the blanket to expose the surgical site.
  3. Place a sterile drape over the clothing and blanket, folding the edge over the non-sterile part.
  4. Raise the arm upward and slightly lift the shoulder off the table.
  5. Place a sterile towel or drape under the shoulder and armpit for proper coverage.

Prepare the Following Areas:

  • The upper arm (from the shoulder down to just below the elbow).
  • The base of the neck up to the top of the shoulder.
  • The scapula (shoulder blade).
  • The chest area down to the midline.
  • The entire upper arm to ensure a sterile surgical field.

- Upper arm preparation for surgery

Steps:

  1. Remove the patient’s clothing and adjust the blanket to expose the surgical site.
  2. Lift the arm and shoulder off the table to allow proper positioning.
  3. Place a sterile towel or drape under the shoulder and armpit for coverage.
  4. Prepare the surgical area, including:
    • The entire circumference of the arm down to the wrist.
    • The armpit (axilla).
    • The upper part of the shoulder blade (scapula).

- Preparation of the Elbow and Forearm

  1. Remove the patient’s clothing and lift the blanket below the area to be prepared.
  2. Raise the arm and shoulder above the table.
  3. Place a sterile drape or towel under the arm and armpit.
  4. Prepare the entire area, including the armpit, shoulder, and hand.

- Hand Preparation

Steps:

1. Raise the arm and support it above the elbow.

2. Place a sterile towel over the arm, under the hand.

3. Prepare the area, including:

o   The hand (front, back, and between the fingers).

o   The forearm up to above the elbow.

- Preparation of the Chest and Breasts

Steps:

1. The anesthesiologist turns the patient’s head away from the area to be cleaned.

2. Remove the patient’s clothing and adjust the blanket below the preparation site.

3. Place a sterile towel or drape over the edge of the unsterile blanket and fold it inward.

4. Place a sterile towel or drape on the table under the shoulder on the affected side.

Prepare the area, including:

  • The shoulder.
  • The armpit.
  • The chest.
  • From the sternum to the opposite shoulder.

- Preparation of the Lateral Abdominal Area

Steps:

1. Remove the patient’s clothing and adjust the blanket below the preparation site.

2. Place a sterile towel or drape over the edge of the unsterile blanket and fold it inward.

3. Raise the arm upward during the preparation process.

4. Prepare the area, including:

  • The armpit.
  • The chest.
  • The abdomen, from the neck to the iliac crest.

5.     For kidney surgeries, the prepared area should include:

  • Above the armpit.
  • Down to the pubic region.
  • Below the midline, both anteriorly and posteriorly.

- Vaginal preparation

Steps:

1. Remove the patient’s clothing and lift the blanket to just below the navel.

2. Place a sterile towel or drape over the edge of the blanket and fold it inward.

3. Place a sterile towel or drape under the buttocks.

Prepare the area, including:

  • The pubic region.
  • The vulva.
  • The labia.
  • The perineum.
  • The anus.

4. Dispose of the sponge after cleaning the anal area.

5. Use a new sponge to clean the thighs from the labia outward (one sponge per thigh).

6. Clean the vagina using a fresh sponge.

7. Apply an ample amount of antiseptic solution inside the vagina.

8. Thoroughly dry the vaginal area with a sponge.

- Pubic region preparation

Steps:

1. Remove the patient’s clothing and lift the blanket above the pubic area.

2. Place a sterile towel or drape over the blanket and fold it inward.

3. Place a sterile towel or drape under the buttocks.

4. Prepare the area from the pubic region to the genitalia and around the navel.

5. Dispose of the gauze after wiping the anal area.

6. Clean the thighs with a fresh sponge (use a separate sponge for each thigh).

7. For Abdominal Perineal surgeries, use two separate trays:

o   Prepare the Recto-Perineal area first using one tray.

o   Use the second tray for abdominal preparation.


- Knee Preparation for surgery

Steps:

1. Remove the patient’s clothing and lift the blanket below the pubic area.

2. Place a sterile towel or drape over the edge of the blanket and fold it inward.

3. Lift the leg while supporting it at the foot.

4. Place a sterile towel or drape on the operating table under the knee.

5. Prepare the area, including:

o   The entire circumference of the thigh.

o   The lower leg down to the heel.

- Preparation of the Wrist and Foot

Steps:

1. Raise the leg upwards while supporting it at the knee.

2. Place a towel or cover on the operating table under the raised leg.

3. Prepare the area to include:

o   The entire foot and between the toes.

o   The entire circumference of the wrist and the leg up to the knee.

- Preparation of Wound Injuries

Steps:

1. Remove the patient's clothing and move the blanket away from the preparation area.

2. Place a towel or cover over the blanket and fold it inward.

3. Place a gauze pad over the wound, then clean the surrounding area thoroughly.

4. Dispose of the used gauze pad.

5. Change gloves before cleaning and washing the wound.

6. To wash the wound, use warm saline solution and pour it over the wound using a syringe, directing the solution inside the wound.

7. The fluid draining from the wound during cleaning should be collected in a kidney dish.

o   If a large amount of fluid is used, prepare a bucket to empty the kidney dish when it fills up.

8. Clean the wound with a colorless antiseptic solution.

9. Dispose of any wet towels.

- Preparation for Skin Grafting

Steps:

1. Remove the patient's clothing and move the blanket to just below the area that needs preparation.

2. Place a towel or cover on the edge of the blanket and fold it.

3. Prepare the surgical area for the scalpel by expanding the preparation area as much as possible.

4. To disinfect the area, use a colorless antiseptic such as Cetrimide or Savlon.

5. Dispose of the used gauze.

6. Use a new sponge to clean the recipient surgical site, expanding the area as much as possible.

7. The sponge used for the donor site should not be used for the recipient site.