By Esther Espunyes, EORNA President

Last week, I reflected on how organisational culture creates the foundation for safe surgery. This week, I want to focus on where safety first becomes tangible: the preoperative pathway.

The quality of surgical outcomes is often determined before a patient enters the operating room. Prehabilitation reminds us that preparing patients physically, nutritionally and psychologically is an evidence-based strategy that improves recovery, resilience and postoperative outcomes.

Equally important is the rigorous application of perioperative infection prevention: evidence-based preoperative showering and bathing, nasal decolonization when indicated, best practice in the preoperative holding area, appropriate hair removal only, when necessary, meticulous surgical hand antisepsis, effective intraoperative skin antisepsis, and the correct use of antiseptic agents and surgical drapes.

However, protocols alone are not enough. Safe practice depends on perioperative professionals receiving continuous education and regular training to remain aligned with the latest evidence-based recommendations. Leadership must foster this culture by integrating best practices into checklists, auditing compliance, and transforming evidence into everyday clinical practice through continuous quality improvement. Also, the best solutions are always integrative models that are based on strong levels of scientific evidence.

Safe surgery is not defined by the first incision—it is defined by every evidence-based decision made beforehand.

Next week, I will reflect on why preventing surgical site infections requires excellence at every stage of the surgical journey, because every step truly counts.

#EORNAPresidentInsights #EORNAReflections #PatientSafety #EuropeanPerioperativeLeadership