# Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care

Source: https://onco.cc/protocols/surgical-site-infection-prevention/  
OnCo record `surgical-site-infection-prevention` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Wound infections after an operation are common and mostly preventable. Before surgery you shower, hair is clipped rather than shaved if it has to go, a single dose of antibiotic is given shortly before the cut when the operation needs it, and the skin is cleaned with chlorhexidine in alcohol. You are kept warm during the operation, and the wound is covered and cared for cleanly afterwards.

## Summary

NICE NG125 (2019, updated 2020) and the WHO global guidelines (2nd edition, 2018) agree on the core. Shower or bathe with soap before surgery (WHO conditional, moderate quality: plain or antimicrobial soap). Do not remove hair routinely; if needed, use clippers, never razors (WHO strong, moderate). Give antibiotic prophylaxis for clean-contaminated and contaminated operations and implants, before incision (WHO strong, low quality) and within 120 minutes of it (WHO strong, moderate), repeating it if the operation outlasts the drug's half-life; do not continue it after the operation (WHO strong, moderate) or because a drain is in place (WHO conditional, low). Prepare the skin with alcohol-based chlorhexidine (WHO strong, low to moderate; NICE first choice unless next to a mucous membrane). Keep the patient warm, consider triclosan-coated sutures (both), and cover the wound at the end of the operation; shower after 48 hours (NICE).

They differ in places. On oxygen, WHO suggests 80% inspired oxygen during and for 2 to 6 hours after intubated general anaesthesia (conditional, moderate), while NICE asks for enough oxygen to keep saturation above 95%. For elective colorectal surgery, WHO suggests oral antibiotics combined with mechanical bowel preparation (conditional, moderate) and recommends against bowel preparation alone (strong, moderate); NICE says not to use mechanical bowel preparation routinely and does not address oral antibiotics. On wound irrigation, NICE says do not irrigate, while WHO suggests considering aqueous povidone-iodine irrigation (conditional, low). WHO suggests prophylactic negative pressure dressings on high-risk closed wounds (conditional, low); NICE NG125's recommendations do not mention them. Nasal mupirocin for Staphylococcus aureus carriers is recommended by WHO for cardiothoracic and orthopaedic surgery (strong) and suggested for others; NICE leaves it to local decision.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: SSI prevention; SSI bundle; wound infection prevention; surgical antibiotic prophylaxis; chlorhexidine skin prep; preoperative shower; hair clipping before surgery

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