those with myelomeningocele (16).

G. Technique (See Procedures Website

for Video)

A 3- to 5-minute “scrub” (vigorous washing up to the elbows)

is necessary when entering the nursery. Subsequently, a 15-

to 30-second hand washing is indicated prior to and after

each patient contact.

1. Preparation for a minor procedure

a. Definition of a minor procedure

(1) Short duration (5 to 10 minutes); noncomplex

(2) Does not involve an area, such as the central

nervous system (CNS), which is especially vulnerable to infection

(3) Does not require skin incision

(4) Includes blood drawing, placement of percutaneous peripheral venous line, bladder tap,

punch-skin biopsy

b. Preparation of personnel

(1) Wear cap/beard cover if hair is likely to contaminate the field.

(2) Remove all jewelry from hands and arms.

(3) Wash hands, wrist, forearms, and elbows, using

a small amount of antiseptic preparation (e.g.,

iodophor or chlorhexidine). Iodophor preparations appear to be equally effective when applied

with disposable sponges or brushes. Vigorous

scrubbing with a brush leads to skin breakdown

and possible contamination and is contraindicated. Be sure to include between the fingers

and the lateral surface of the fifth finger.

(4) Clean nails with stick.

(5) Wash/scrub hands and forearms to elbow with

antiseptic for an additional 2 to 3 minutes.

36 Section I ■ Preparation and Support

(6) Rinse hands and forearms with running water,

keeping them elevated above elbows.

(7) Use towel to shut off water if knee- or footoperated faucets are not available.

(8) Dry hands with a clean towel prior to drying

forearms.

(9) Wear gloves.

c. Preparation of patient skin

(1) If necessary, cut hair in area of procedure with

small scissors, taking care not to nick skin. Avoid

shaving, as it may compromise skin and

increases the risk of infection.

(2) Apply antiseptic.

(a) Alcohol may be used. Preparation with

iodophor may be optimal, but color tends to

obscure underlying vessels.

(b) Apply three times in circles progressing

away from procedure site.

(c) Apply with some friction.

(d) Allow to dry. Do not wipe off antiseptic.

(e) Never touch skin after application of antiseptic and before initiation of the procedure.

(f) If using alcohol, reapply it prior to every

attempt at procedure.

2. Preparation for a major procedure

a. Definition of major procedure

(1) Invasive or involving skin incision

(2) Includes central line placement, cutdown, chest

tube, lumbar puncture

(3) Duration longer than 5 to 10 minutes

b. Masks, drapes, and gowns. Clothing is an important

barrier to microorganisms shed into the air from the

skin and mucous membranes. Surgical masks and

gowns must be registered by the FDA to demonstrate safety and efficacy (17).

(1) Put on cap and mask.

(2) Clean nails and “scrub” as for minor procedure,

but continue for 4 to 5 minutes.

A B

C D