|Category (if mentioned)
|“Thoroughly wash and clean at and around the incision site to remove gross contamination before performing antiseptic skin preparation.”3
|“Perform intraoperative skin preparation with an alcohol based antiseptic agent unless contraindicated.”4
Category IA–strong recommendation; high quality evidence
|“Apply preoperative antiseptic skin preparation in concentric circles moving toward the periphery. The prepared area must be large enough to extend the incisionor create new incisions or drain sites, if necessary.”3
|“Application of a microbial sealant immediately after intraoperative skin preparation is not necessary for the prevention of SSI.”4
|Category II–weak recommendation; low quality evidence
|“The use of plastic adhesive drapes with or without antimicrobial properties is not necessary for the prevention of SSI.”4
|Category II–weak recommendation; high to moderate-quality evidence
|”Use surgical gowns and drapes that are effective barriers when wet (i.e., materials that resist liquid penetration).”
|“The panel recommends alcohol-based antiseptic solutions based on CHG for surgical site skin preparation in patients undergoing surgical procedures.”
Strong recommendation, low to moderate quality of evidence
|“The panel suggests that antimicrobial sealants should not be used after surgical site skin preparation for the purpose of reducing SSI.”
|Conditional recommendation, very low quality of evidence
|“The panel suggests that either sterile, disposable, non-woven or sterile, reusable woven drapes and surgical gowns can be used during surgical operations for the purpose of preventing SSI.”
|Conditional recommendation, moderate to very low quality of evidence
|“The panel suggests not to use plastic adhesive incise drapes with or without antimicrobial properties for the purpose of preventing SSI.”
|Conditional recommendation, low to very low quality of evidence
“Do not use non-iodophor-impregnated incise drapes routinely for surgery as they may increase the risk of surgical site infection.”
“If an incise drape is required, use an iodophor-impregnated drape unless the patient has an iodine allergy.”
“Prepare the skin at the surgical site immediately before incision using an antiseptic preparation.”
“Be aware of the risks of using skin antiseptics in babies, in particular the risk of severe chemical injuries with the use of chlorhexidine (both alcohol-based and aqueous solutions) in preterm babies.”
“When deciding which antiseptic skin preparation to use, options may include those in table 1.” (Table 1 see below)
“If diathermy is to be carried out:use evaporation to dry antiseptic skin preparations
andavoid pooling of alcohol-based preparations.”
The commission recommends, in the operating room, thorough antisepsis of the skin in the operating area should be carried out using an alcohol-based skin antiseptic. By adding a remanent antiseptic, a lasting effect beyond the effect of alcohol is achieved. Which active substance is to be preferred is currently unclear.
|For antiseptics on mucous membranes and the eye, use antiseptics approved for the respective area of application. Keep the skin area thoroughly wetted and moist during the declared exposure time, preferably by applying the antiseptic several times. Pay attention to the longer exposure time on skin areas rich in sebaceous glands. Care must also be taken to ensure that the patient does not lie in an accumulation of fluid from the skin antiseptic, as this can lead to skin necrosis and deflagration.
|After antisepsis of the surgical field, the area surrounding the surgical site must be sterilely draped. For operations where moisture penetration cannot be ruled out, use liquid-impermeable drapes. The use of non-antiseptic impregnated incision drapes is not recommended.
Surgical ring drapes do not offer demonstrable advantages in terms of prevention of SSI in all operations.