WHO recommendations on choice of antiseptic agent and method of application for preoperative skin preparation for caesarean section

Recommendation a: The use of alcohol-based chlorhexidine gluconate for skin preparation prior to elective or emergency caesarean section is recommended. (Recommended)

Recommendation b: The method of application of alcohol-based chlorhexidine gluconate prior to caesarean section should be based primarily on instructions for use, the clinician’s experience and preferences. (Recommended)

Remarks:
  • There was a lack of evidence to recommend a specific concentration of chlorhexidine gluconate; however, most trials included used 2% chlorhexidine gluconate in 70% alcohol.
  • Maternal allergy to alcohol-based chlorhexidine gluconate must be excluded before surgery. In women with no previous history of allergy to alcohol-based chlorhexidine gluconate, it should be noted that chlorhexidine gluconate can cause skin irritation.
  • A standard preoperative skin preparation technique that is appropriate for the intended skin incision must be followed.
  • As alcohol is highly flammable, alcohol-based antiseptic preparations may ignite if used in the presence of diathermy, and they must be allowed to dry by evaporation. It is advisable to ensure that the drapes are not saturated with alcohol or that the alcohol-based solution has not formed a pool underneath the woman before starting surgery. Particular care should be taken at emergency caesarean section.
  • Where chlorhexidine gluconate is not available, other antiseptic agent such as povidone-iodine can be considered a suitable antiseptic agent for preoperative skin preparation, although it is not as effective as alcohol-based chlorhexidine gluconate.
  • The Guideline Development Group noted that the current recommendation is consistent with the 2016 WHO global guidelines on the prevention of surgical site infection, which recommends chlorhexidine gluconate alcohol-based antiseptic solutions for surgical site skin preparation in individuals undergoing surgical procedures.
  • These recommendations supersede Recommendation No. 17 of the 2015 WHO recommendations for prevention and treatment of maternal peripartum infections where this was considered a conditional recommendation based on low-quality evidence.

From: Executive summary

Cover of WHO recommendations on choice of antiseptic agent and method of application for preoperative skin preparation for caesarean section
WHO recommendations on choice of antiseptic agent and method of application for preoperative skin preparation for caesarean section [Internet].
© World Health Organization 2021.

Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing.

Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.

Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”.

Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/).

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.