SELF/Perioperative Nursing/Skin Preparation/Psychomotor Skills Practice Instructions
Skin Preparation and Draping – Perioperative Nursing (ECSACONM)
[edit | edit source]Overview
[edit | edit source]This page provides a psychomotor skills practice guide for skin preparation and draping, developed for perioperative nursing training under ECSACONM (East, Central and Southern Africa College of Nursing). It is intended as a self-directed developer worksheet, outlining the sequential steps, associated learning objectives ("good skills"), common errors, and practical guidance for each stage of preparing and draping the surgical site.
To promote efficient use of resources, items such as sterile packs, drapes, gloves, and other consumables may be used in an unsterile state for practice purposes. During all skills practice activities, learners should handle and use these items as though they are sterile and intended for patient care, demonstrating correct aseptic technique and adherence to sterile principles throughout the procedure.
NB:
- The below skills should be practiced with an assistant.
- The patient could be a real person or a full-body-size mannequin.
Purpose
[edit | edit source]To guide nursing students and practitioners through a systematic, step-by-step process for preparing and draping the surgical site, ensuring patient safety, infection control, and correct aseptic technique.
Psychomotor Skills Practice Instructions
[edit | edit source]| Step | Instructions | Good Skills (Learning Objectives) | Common Errors | Guidance |
|---|---|---|---|---|
| 1 | Gather supplies | Articulates all supplies are gathered and ready for the procedure | ||
| 2 | Expose and position surgical site | Don non-sterile gloves; expose only the surgical site; position patient/limb for access; protect lines/tubes; maintain modesty.
Good skills: Non-sterile gloves donned; only the surgical site is exposed, with modesty preserved through draping or coverings and optimal site accessibility achieved; for a hand or foot, the entire hand/foot is exposed up to the elbow/shin; patient comfortable and stable |
Overexposing patient unnecessarily; poor site visibility; tension on patient lines or tubes; patient needing to hold an awkward position | Do a quick line-check before and after repositioning; confirm you can drape without moving the limb again. |
| 3 | Initial gross cleaning of skin (if visibly soiled) | Articulates gently removing visible dirt, blood, or oils with clean water, normal saline (0.9% sodium chloride), or mild soap and water before antiseptic prep | ||
| 4 | Hair removal at incision site (if indicated) | Articulates clipping hair if it interferes with incision/drape adhesion | ||
| 5 | Perform hand hygiene and don gloves | Articulates: hand hygiene properly performed and sterile gloves donned without contamination | ||
| 6 | Sterile skin prep application (flat skin) | Apply sterile antiseptic solution to the surgical site using aseptic non-touch technique. Begin at incision/injection site; move outward in widening circles; single-use applicators; maintain contact time. Assistant presents prep supplies and maintains patient position.
Good skills: Begins at incision or injection site and moves outward in widening circles; maintains single-use of applicators; maintains adequate contact time; carefully manages skin folds and dependent areas to prevent antiseptic pooling and incomplete drying, especially with alcohol-based antiseptics |
Going back over cleaned area with used applicator; scrubbing too harshly; not allowing adequate drying time | Think "clean to less clean"—once you move outward, don't return inward with the same applicator. |
| 6 (variant) | Sterile skin prep application for curved or complex anatomical areas (e.g., axilla, groin, neck) | Apply antiseptic with short overlapping strokes that follow the body's contours. Separate skin folds as needed to prepare every surface. Use a new applicator whenever one becomes contaminated or heavily soiled. Allow all folds to dry completely. Assistant supports body parts and presents fresh applicators.
Good skills: Applies antiseptic carefully in small, overlapping strokes following natural contours; starts from incision site outward and ensures full coverage of folds; uses new applicators for soiled areas; allows antiseptic to dry completely, especially in folds; uses povidone-iodine or chlorhexidine gluconate for mucous membranes instead of alcohol-based solutions |
Random application; missing areas in folds; going back over prepped areas; reusing gauze/sponges in folds; not allowing adequate drying time | During practice, deliberately inspect every fold before considering the preparation complete. Rotate the model or patient rather than stretching awkwardly. |
| 6 (variant) | Sterile skin prep for small joints (e.g., hands) | Apply sterile antiseptic using aseptic non-touch technique. Begin with fingertips circumferentially (nail beds, web spaces), then palm/dorsum, then wrist/forearm outward. Assistant supports body parts and presents fresh applicators.
Good skills: Begins at the fingertips and works around each finger circumferentially, including nail beds and interdigital spaces; pays special attention between fingers and under nails; moves from fingers to the palm in concentric outward strokes; paints the dorsum similarly, including the web spaces and metacarpals; continues painting up the wrist and forearm in circular, outward-moving strokes; does not return the sponge to already-prepped areas once it has moved outward; protects surrounding sterile surfaces during manipulation of digits and small joints to reduce recontamination risk |
Missing interdigital spaces; prepping too rapidly; going back from the forearm to the fingers with the same sponge—prep should flow from clean to less clean | Slow down at nails and between fingers—these areas are commonly missed. |
| 7 | Allow antiseptic to dry completely | Pause to give the antiseptic time to completely dry prior to draping (especially alcohol-based preps).
Good skills: Ensures complete drying time (especially important with alcohol-based preps to prevent ignition); confirms antiseptic solution is fully dry to avoid compromising adhesive drapes and fire risk |
Draping while skin is wet; rushing the process (fanning, blowing, or using non-sterile items to "speed up" drying) due to time pressure, causing elevated risk of ignition with electrocautery | Treat drying as a safety checkpoint—wet alcohol prep increases ignition risk with cautery. |
| 8 | Plan for skin window | Articulates: placement of towels and drapes exposes just enough for surgical access while maintaining patient modesty and protects IV lines and other devices away from the proposed sterile field | ||
| 9 | Apply initial sterile towels around the incision site (flat skin) | Place towels starting closest to incision then work outward; overlap edges; clamp only if needed. Assistant passes towels and secures them if requested.
Good skills: Places towels starting closest to the incision; works outward; edges overlap slightly, with clamps if necessary |
Gaps between towels; wrinkled or loose towels; poor overlap causing contamination risk; injury to patient with towel clamps | Once a towel touches skin, avoid repositioning—replace instead if placement is incorrect. |
| 9 (variant) | Apply initial sterile towels around the incision site (curved and complex areas) | Position towels so they follow the natural contours of the body. Overlap towels across folds and joints to maintain continuous sterile coverage. Secure them without creating tension that causes movement. Assistant supports the body part and assists towel placement.
Good skills: Places towels to follow the body's natural contours and curves; uses overlapping technique to allow continuous coverage over irregular surfaces; adjusts placement to accommodate folds, creases, and joints; positions towels firmly so they do not shift; positions towels to direct fluid away from the operative site |
Applies towels as if the surface were flat (ignoring contours); leaves gaps in skin folds or around joints; fails to cover difficult-to-reach areas; towels slipping or shifting | View the operative site from multiple angles during practice to identify hidden gaps before continuing. |
| 9 (variant) | Apply initial sterile towels around the prepped limb | Place prepped limb on sterile towel over armboard; create sterile boundary around limb; cover proximally; clamp if needed; alternate: stockinette. Avoid contamination risks associated with repositioning sterile towels once placed. Assistant supports the limb and assists towel or stockinette placement.
Good skills: Limb isolated with complete sterile boundary; armboard covered; towels secure; stockinette used correctly if available; places the prepped hand on a sterile towel covering the armboard; works around the prepped limb to create the sterile boundary; places the covering towel proximal to the elbow; clamps if necessary; alternate: a sterile stockinette can be rolled up the arm; protects pressure points and maintains limb stability during draping |
Prepped limb placed on armboard without towel; gaps between towels; wrinkled or loose towels; poor overlap causing contamination risk; injury to patient with towel clamps | Keep limb centered; secure boundary to prevent drift during the case. |
| 10 | Place adhesive or utility drapes if used | Apply adhesive drapes smoothly; press edges firmly; avoid wrinkles/bubbles; ensure adhesion.
Good skills: Applies adhesive drapes smoothly without wrinkles; covers area around incision firmly; assesses for patient sensitivity or skin fragility before application of adhesive drapes |
Bubbles, wrinkles, loose edges; drape lifting during surgery | If adhesive won't stick (wet prep/hair), correct the cause rather than forcing the drape. |
| 11 | Drape the operative field with larger drapes | Place large drapes head-to-foot then sides; align fenestration over site without moving towels. Assistant helps with unfolding and positioning large drapes.
Good skills: Places large drapes from head to foot, then sides; avoids unnecessary movement once large sterile drapes are positioned to reduce contamination risk; secures fenestration precisely over the surgical site without moving towels |
Drapes applied backward or upside-down; drapes slipping and exposing non-sterile skin | Confirm orientation before dropping the drape; once placed, avoid "sliding" over prepped skin. |
| 12 | Secure drapes and edges | Anchor drapes to maintain coverage; allow safe routing for tubing/instruments. The assistant helps apply securing devices and organize tubing.
Good skills: Drapes anchored securely to maintain coverage; flexible adjustments made for instruments or tubing |
Drapes shift during procedure; unsecured edges fluttering or falling; excessive tension causing skin injury or drape displacement during the procedure | Secure edges early—unstable drapes become contamination risks later. |
| 13 | Check the sterile field perimeter | Visually sweep the perimeter: only sterile surfaces exposed; no gaps/wrinkles/exposed skin.
Good skills: Confirms that only sterile surfaces are exposed around the surgical site, with no gaps, wrinkles, or exposed skin |
Missed gaps; drapes shifted exposing skin or non-sterile areas; poor sterile barrier integrity | Actively monitor drape integrity; communicate immediately if compromised; replace contaminated drapes/items as needed. |
| 14 | Perform final readiness verification before incision | Articulates confirmation that the field is dry, stable, fully exposed, and free from contamination |
References
[edit | edit source]
| Authors | Ian-laurel |
|---|---|
| License | CC-BY-SA-4.0 |
| Organizations | SELF, ECSACONM |
| Cite as | "SELF/Perioperative Nursing/Skin Preparation/Psychomotor Skills Practice Instructions". Appropedia. 2026. Retrieved July 14, 2026. |