Pre-operative hygiene

An important part of our daily routine is to keep ourselves clean – this is a major part of preventing infection – your skin is the physical barrier that keeps out germs and bugs. It is also very important that you take good care of your teeth and gums – this too will help reduce your chances of getting an infection.

Any operation or procedure poses a risk of infection, although in most cases this risk is low. Your surgeon will discuss the specific risk to your child, as it depends on the type of operation your child is having. Almost all operations involving breaking the skin in some way – either through an incision (cut), through a cannula (thin plastic tube) placed into a blood vessel, or by having a tube in your mouth (to help you breath during their operation). The risk of infection getting inside the body can be reduced by having clean skin and good mouth care.

Here we explain why it is so important for your child to have clean skin and good mouth care before the operation and what measures we have put in place at Great Ormond Street Hospital (GOSH) to reduce the risk of infection before, during and after an operation.

In addition to the surgical incision, it is likely that your child will have one or more cannulas inserted into a vein or a drainage tube from the operation site. Some children also need to have a urinary catheter (thin plastic tube placed into the bladder). All of these give germs a route inside the body. If the skin around them is dirty, the germs are more likely to travel through the cannula or drain. Having a thorough wash before an operation can reduce this risk.

No, either is fine. What is important is that your child uses liquid soap and a clean sponge or flannel to clean the skin. Having a bubble bath or just standing under the shower is not enough to remove germs. Afterwards, your child should dry themselves thoroughly with a clean towel. Damp skin can encourage bugs to grow. Wherever possible, your child should have their own towel that is not used by any other member of the family.

No. It is just as effective to use plain family soap but children often find liquid soap easier to use. However, if your child has an existing infection on their skin you may be given a different soap to use. Your clinical team will talk to you about this.

Your child should wash every part of their body thoroughly. The diagram below shows the areas to concentrate on particularly and the reasons why.

Yes. This is particularly important if they are having an operation on their head or face. Some wards will ask you to wash your child’s hair with an antiseptic shampoo, particularly before brain surgery. When you have washed your child’s hair, please do not apply any gel, spray or oil as this could make the hair dirty again.

If you suspect that your child has head lice, please warn us before the operation. We would prefer you to treat the head lice using a bug busting comb or treatment mousse before you come to GOSH. Your community pharmacist (chemist) can advise you about treatment methods available.

Your mouth is important for eating, drinking, speech and breathing but it is also another defence against infection. Having a clean mouth and healthy gums can stop germs travelling inside the body.

If your child has teeth, they should clean them twice a day with fluoride toothpaste. On the morning of surgery, you should clean their teeth as usual, but not use mouthwash or swallow any water or toothpaste.

If your child does not have any teeth, you should check their mouth for any signs of infection, such as white spots, breaks in their gums or sore patches. If you find any of these signs, please tell your clinical team.

You should be able to follow your usual washing routine, as the soap-substitutes you use should be able to remove germs from the skin. If possible, on the morning of surgery, do not re-apply any ointments or emollients after washing. If you have any concerns about your child’s skin condition, please talk to your dermatologist (specialist skin doctor).

It is important that your child does not have any nail varnish on their nails before the operation. Our anaesthetists use nail colour as an indicator of how your child is reacting to the anaesthetic so it is important that they can see your child’s nails clearly. We also advise keeping your child’s nails short so that they are easier to keep clean. Short nails will also stop any skin damage if they are itchy after the procedure.

We will ask whether your child has had a bath or shower the evening before surgery or that morning when you come to GOSH for the operation. This is part of the routine checks we carry out to make sure that your child is fit and well for surgery.

In most cases, we will then mark your child’s skin to identify the area of the body where the procedure or operation is due to take place. We use a permanent marker so this mark is not removed accidentally but it will gradually fade and wash off after the operation. This is an additional safety measure we have introduced – we will explain more to you and your child on the day of your operation.

As part of our plan to reduce infections after surgery, nurses on the ward will check your child’s operation site and any intravenous or drain sites regularly. This helps us to spot any infection quickly and start treatment. Any drains, catheters or cannulas your child has will be removed when they are no longer needed.

Often your child’s operation site will need to be kept dry after the operation. We will talk to you about when your child can have a bath or shower – this will vary depending on your child’s operation – and how to look after the operation site and any stitches or dressings.