Barrier and no-touch techniques in gastrointestinal surgery: a best evidence summary

To systematically summarize the best available evidence on intraoperative barrier and no-touch techniques for the prevention of surgical site infection (SSI) in adult patients undergoing gastrointestinal (GI) surgery, and to provide an evidence base for developing standardized clinical practice protocols.

Guided by the "6S" evidence model, a systematic literature search was conducted across multiple databases from their inception to March 1, 2026. The search encompassed all evidence pertaining to intraoperative barrier and no-touch techniques in GI surgery, including guideline organization websites (WHO, CDC, NICE, SHEA/IDSA, APIC, GIN, NGC, SIGN, RNAO, and medlive.cn), evidence-based databases (The Cochrane Library and JBI Evidence Synthesis), the trial registry ClinicalTrials.gov, and the databases PubMed, Web of Science, Embase, CINAHL, CBM, CNKI, VIP, and WanFang. Included studies comprised guidelines, expert consensus statements, evidence summaries, systematic reviews, narrative reviews, and randomized controlled trials (RCTs). Quality assessment, data extraction, and evidence grading were independently performed by two researchers trained in evidence-based nursing.

A total of 18 publications were included: 5 guidelines, 3 expert consensus statements, 1 evidence summary, 3 systematic reviews, 3 narrative reviews, and 3 RCTs. Thirty best-evidence statements were synthesized across six domains: no-touch isolation technique (NTIT)-derived contamination control, intraoperative aseptic barrier precautions, intraoperative wound protection, selection of intraoperative irrigation solutions, intraoperative temperature management, and surgical teamwork and instrument management.

This evidence summary provides a standardized, SSI-focused framework for barrier and no-touch practices in GI surgery. High-level evidence supports wound protectors, mechanical bowel preparation plus oral antibiotics in elective colorectal surgery, and intraoperative normothermia, whereas most NTIT-derived contamination-control practices are supported mainly by expert-consensus evidence and are recommended conditionally (Grade B). Clinical translation should be guided by the FAME (Feasibility, Appropriateness, Meaningfulness, and Effectiveness) framework and tailored to local hospital conditions and individual patient characteristics to minimize the risk of SSI.