Surgical field cleaning and disinfection is mandatory for most procedures that involve a skin incision, with the exception of IV, IM, and subcutaneous injections as well as peripheral vein catheterization, which are associated with the lowest risk of infection.
Sterile gown, sterile gloves, facemask, cap, sterile forceps, sterile gauze swabs or preprepared single-use cleaning swabs, disinfectant solution (chlorhexidine is preferred over povidone or iodophorEvidence 1Weak recommendation (benefits likely outweigh downsides, but the balance is close or uncertain; an alternative course of action may be better for some patients). Moderate Quality of Evidence (moderate confidence that we know true effects of the intervention). Quality of Evidence lowered due to the risk of bias. Privitera GP, Costa AL, Brusaferro S, et al. Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: A systematic review and meta-analysis. Am J Infect Control. 2017 Feb 1;45(2):180-189. doi: 10.1016/j.ajic.2016.09.017. Epub 2016 Nov 9. PMID: 27838164.), sterile drapes (alternatively single-use adhesive drapes), scissors.
1. Disinfect your hands and wear sterile clothes: Wear a cap and facemask. Wash and disinfect your hands using a surgical technique. Wear a sterile gown and avoid touching its external surface. Put on sterile gloves using an aseptic technique, ensuring that the external (sterile) surface of the gloves is never in contact with your hands or any other nonsterile surface. From this point on, only sterile surfaces can be touched; contact with any nonsterile object (eg, a nonsterile instrument, any nonprepared patient’s skin area) requires changing the gloves only or changing both the gloves and the gown, depending on circumstances.
2. Clean and disinfect the surgical field: Identify anatomical landmarks relevant for the planned procedure. Prepare the surgical field with an appropriate margin, bearing in mind that the course of the procedure may vary and extend. Skin hair can be left in place or clipped if thought likely to interfere with the procedure; shaving should not be used as it is associated with an increased risk of skin and soft tissue infections compared with clipping or no hair removal.Evidence 2Weak recommendation (benefits likely outweigh downsides, but the balance is close or uncertain; an alternative course of action may be better for some patients). Low Quality of Evidence (low confidence that we know true effects of the intervention). Quality of Evidence lowered due to the risk of bias and imprecision. World Health Organization. WHO Surgical Site infection Prevention Guidelines. Web Appendix 7. Summary of a systematic review on the effectiveness and optimal method of hair removal. https://www.who.int/gpsc/ssi-web-appendices/en/ Clean the skin using preprepared single-use cleaning swabs or using sterile forceps, grasping a gauze swab folded twice, soaked in the chosen disinfectant solution. Clean the surgical field, moving in a spiral pattern from the middle towards the periphery (the swab that touches the periphery of the field cannot touch the middle of the field again). Repeat this 3 to 4 times, ensuring that the whole surgical field has been uniformly cleaned and disinfected.
3. Drape the surgical field using sterile drapes: Grasp a sterile drape and fold inwards the edge that will touch the surgical field, creating a fold that is 10 to 15 cm wide. Place the drape on the patient’s skin, making sure that the unprepared skin is not touched by the gloves; do not shift the drape from an unsterile area towards the prepared area. If required, use a reverse technique: cover the surgical field using a sterile drape, then pull it to the side to expose the surgical field. Cover the whole area adjacent to the surgical field using sterile drapes, so that the uncovered area is large enough for the planned procedure and identification of necessary anatomical landmarks. The drapes should overlap, covering any nonsterile areas adjacent to the surgical field. Individual drapes can be secured in place with sterile clips. Alternatively, adhesive drapes can be used (in some procedures, eg, lumbar puncture, a single drape with a central opening or 2 drapes with U-shaped cutouts are sufficient).