Although considerable progress has been made in understanding the cause and prevention of surgical site infections during the past 100 years, postoperative wound infections (incisional and deep) remain a leading cause of nosocomial (hospital-acquired) infections, especially in developing countries. The vast majority of postoperative incisional or superficial wound infections are caused by microorganisms (usually bacteria or sometimes fungi) normally found on the patient’s skin or from mucous membranes adjacent to the surgical site, and less often from other sites (e.g., nose, mouth
or respiratory tract in abdominal operations). By contrast, microorganisms from the hands of the surgeon or assistant are seldom the cause of incisional surgical site infections (Galle, Homesley and Rhyne 1978), nor are organisms present in the operating room or on other surgical staff.

Preoperative surgical antisepsis consists of three processes (hand hygiene and gloving of surgical team members combined with applying an antiseptic agent to the surgical site) designed to block transmission of infectious agents into the surgical wound. The effectiveness of handwashing followed by  briefly applying a waterless, alcohol-based antiseptic handrub or antiseptic solution in reducing the number of bacteria and fungi on hands has been amply documented (Galle, Homesley and Rhyne 1978; Larson et al 2001). In fact, one large, 10-year prospective study found no postoperative wound infections after 141 operations during which the surgeon’s glove was punctured (Cruse and Foord 1980). In addition, preoperative skin preparation using an antiseptic agent, when done correctly, has been shown to effectively reduce both transient and resident skin flora, as well as infection rates (Platt and Bucknall 1984).