Turkiye Klinikleri Journal of Nursing Sciences

.: REVIEW
Ameliyat Öncesi Cilt Hazırlığında Güncel Yaklaşımlar: Geleneksel Derleme
Current Approaches to Preoperative Skin Preparation: A Traditional Review
Dilek AYGİNa , Özge YAMANa
aSakarya Üniversitesi Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, Cerrahi Hastalıkları Hemşireliği AD, Sakarya, Türkiye
Turkiye Klinikleri J Nurs Sci. 2024;16(3):920-9
doi: 10.5336/nurses.2023-101080
Article Language: TR
Full Text
ÖZET
Sağlık bakımı ile ilişkili enfeksiyonlar, her yıl dünya çapında yüz milyonlarca insanı etkilemektedir. Cerrahi alan enfeksiyonları (CAE); cerrahi girişim sonrası yara bölgesinde gelişen ancak önlenebilir enfeksiyonlardandır. Gelişiminde çevresel faktörler önemli rol oynamasına rağmen enfeksiyonlar genellikle bireyin kendi florasından kaynaklı gelişmektedir. Normal şartlarda epidermis, bakteriyel invazyonlara karşı vücudu korumakta ve birincil bariyer görevi görerek mikroorganizmaların vücuda girişini engellemektedir. Ancak cerrahi veya diğer invaziv girişimlerde, epidermis bütünlüğü bozulduğundan mikroorganizmaların cilt altına geçişi kolaylaşmaktadır. Bu bakımdan, enfeksiyonların çoğunun kişinin kendi cilt florasından kaynaklandığı düşünüldüğünde, ameliyat öncesi dönemde cilt hazırlığının yapılması ve antisepsisinin sağlanması önem taşımaktadır. Ameliyat öncesi cilt hazırlığının temel amacı, bireyin vücudunda yer alan mikroorganizma yükünün mümkün olduğunca azaltılmasıdır. Optimal antisepsi uygulamaları sonrası dahi cilt florası tamamen yok edilememekte, kontamine cerrahilerde flora yükü daha fazla olmaktadır. Dolayısıyla, ameliyat öncesi cilt hazırlığı uygulamalarının güncel rehberler doğrultusunda doğru bir şekilde uygulanması CAE'lerini azaltmada önemli rol oynamaktadır. Cilt hazırlığı bileşenleri Perioperatif Hemşireler Birliği kılavuzunda; dekolonizasyon, ameliyat öncesi duş, cerrahi alandaki tüyler, cerrahi alan antiseptiğinin seçimi, cerrahi alan antiseptiğinin uygulanması, antiseptiklerin güvenli taşınması ve saklanması, kalite olmak üzere 7 başlık altında ayrılmaktadır. Cilt hazırlığının doğru yapılabilmesi için bu bileşenlerin her birinde dikkat edilmesi gereken önemli noktalar bulunmaktadır. Bu derleme makalede de ameliyat öncesi cilt hazırlığına ilişkin güncel rehber önerileri ve uygulamada dikkat edilmesi gereken noktaların incelenmesi amaçlandı.

Anahtar Kelimeler: Cerrahi yara enfeksiyonu; antisepsis; ameliyat öncesi dönem; cilt; kanıta dayalı uygulamalar
ABSTRACT
Healthcare-associated infections affect hundreds of millions of people worldwide each year. Surgical site infections are preventable infections that develop in the wound area after surgical intervention. Although environmental factors play an important role in its development, infections generally develop due to the individual's flora. Under normal conditions, the epidermis protects the body against bacterial invasions and acts as a primary barrier, preventing microorganisms from entering the body. However, as the integrity of the epidermis is disrupted in surgical or other invasive interventions, it becomes easier for microorganisms to pass under the skin. Considering that the person's skin flora causes most infections, preparing the skin and providing antisepsis in the preoperative period is crucial. The primary purpose of preoperative skin preparation is to reduce the microorganism load on the individual's body as much as possible. Even after optimal antisepsis applications, skin flora cannot be wholly destroyed, and the flora load is higher in contaminated surgeries. Therefore, the correct application of preoperative skin preparation practices in accordance with current guidelines plays an important role in reducing surgical site infections. Skin preparation ingredients; The Association of perioperative Registered Nurses guideline is divided under 7 headings; decolonization, preoperative bathing, surgical site hair, selection of surgical site antiseptic, application of surgical site antiseptic, handling and storage of antiseptics, and quality. There are essential points to consider in each of these components in order to prepare the skin correctly. This review article aimed to examine the current guideline recommendations regarding preoperative skin preparation and the points to be considered in practice.

Keywords: Surgical wound infection; antisepsis; preoperative period; skin; evidence-based practice
REFERENCES:
  1. Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e276-e87. [Crossref]  [PubMed] 
  2. U.S. Department of Health and Human Services [Internet]. [Cited: November 5, 2023]. Health Care-Associated Infections. 2021. Available from: [Link] 
  3. Centers for Disease Control and Prevention [Internet]. [Cited: November 5, 2023]. HAI Data. 2018. Available from: [Link] 
  4. Raoofi S, Pashazadeh Kan F, Rafiei S, Hosseinipalangi Z, Noorani Mejareh Z, Khani S, et al. Global prevalence of nosocomial infection: a systematic review and meta-analysis. PLoS One. 2023;18(1):e0274248. [Crossref]  [PubMed]  [PMC] 
  5. Centers for Disease Control and Prevention [Internet]. [Cited: November 5, 2023]. Types of Healthcare-associated Infections. 2014. Available from: [Link] 
  6. European Centre for Disease Prevention and Control [Internet]. [Cited: November 5, 2023]. Healthcare-associated infections. Available from: [Link] 
  7. Healthy People 2030 [Internet]. [Cited: November 5, 2023]. Healthcare-Associated Infections Workgroup. Available from: [Link] 
  8. Association for Professionals in Infection Control and Epidemiology [Internet]. [Cited: November 5, 2023]. What are healthcare-associated infections?. Available from: [Link] 
  9. Natıonal Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. Clinical Guideline-National Insitute of Health and care Excellence. 2020. p.1-29. www.nice.org.uk/guidance/ng125
  10. Centers for Disease Control and Prevention [Internet]. [Cited: November 5, 2023]. Surgical Site Infection (SSI). 2010. Available from: [Link] 
  11. Mengistu DA, Alemu A, Abdukadir AA, Mohammed Husen A, Ahmed F, Mohammed B, et al. Global incidence of surgical site infection among patients: systematic review and meta-analysis. Inquiry. 2023;60:469580231162549. [Crossref]  [PubMed]  [PMC] 
  12. Bashaw MA, Keister KJ. Perioperative strategies for surgical site infection prevention. AORN J. 2019;109(1):68-78. [Crossref]  [PubMed] 
  13. Dhamnaskar S, Mandal S, Koranne M, Patil P. Preoperative surgical site hair removal for elective abdominal surgery: does it have impact on surgical site infection. Surg J (N Y). 2022;8(3):e179-e86. [Crossref]  [PubMed]  [PMC] 
  14. Gupta N, Nagar A, Meena D, Meena RS, Kumar S. Clinical evaluation of preoperative skin preparation with aqueous povidone iodine only and in combination with alcoholic chlorhexidine in patients undergoing clean elective surgeries. Journal of Clinical Images and Medical Case Reports. 2023;4(3):2319. [Crossref] 
  15. Jolivet S, Lucet JC. Surgical field and skin preparation. Orthop Traumatol Surg Res. 2019;105(1S):S1-S6. [Crossref]  [PubMed] 
  16. Beausoleil C, Comstock SL, Werner D, Li L, Eby JM, Zook EC. Antimicrobial persistence of two alcoholic preoperative skin preparation solutions. J Hosp Infect. 2022;129:8-16. [Crossref]  [PubMed] 
  17. Scallan RM, Gerathy S, Price J, Lazarus AM, Metter EJ, Talbot LA. Preoperative chlorhexidine gluconate bathing on a military medical-surgical unit. Mil Med. 2020;185(Suppl 2):15-20. [Crossref]  [PubMed] 
  18. Edmiston CE Jr, Leaper D. Should preoperative showering or cleansing with chlorhexidine gluconate (CHG) be part of the surgical care bundle to prevent surgical site infection? J Infect Prev. 2017;18(6):311-4. [Crossref]  [PubMed]  [PMC] 
  19. Cowperthwaite L, Holm RL. Guideline implementation: preoperative patient skin antisepsis. AORN J. 2015;101(1):71-7; quiz 78-80. [Crossref]  [PubMed] 
  20. Link T. Guidelines in practice: preoperative patient skin antisepsis. AORN J. 2022;115(2):156-66. [Crossref]  [PubMed] 
  21. Septimus EJ, Schweizer ML. Decolonization in prevention of health care-associated infections. Clin Microbiol Rev. 2016;29(2):201-22. [Crossref]  [PubMed]  [PMC] 
  22. Stanton C. Guideline for preoperative patient skin antisepsis. AORN J. 2021;113(4):P5-P7. [Crossref]  [PubMed] 
  23. WHO. Global Guidelines for the Prevention of Surgical Site Infection, second edition [Internet]. World Health Organization. Geneva; 2018. Available from: [Link] 
  24. Ling ML, Apisarnthanarak A, Abbas A, Morikane K, Lee KY, Warrier A, et al. APSIC guidelines for the prevention of surgical site infections. Antimicrob Resist Infect Control. 2019;8:174. [Crossref]  [PubMed]  [PMC] 
  25. Calderwood MS, Anderson DJ, Bratzler DW, Dellinger EP, Garcia-Houchins S, Maragakis LL, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol. 2023;44(5):695-720. [Crossref]  [PubMed]  [PMC] 
  26. Franco LM, Cota GF, Pinto TS, Ercole FF. Preoperative bathing of the surgical site with chlorhexidine for infection prevention: Systematic review with meta-analysis. Am J Infect Control. 2017;45(4):343-9. [Crossref]  [PubMed] 
  27. Ammanuel SG, Edwards CS, Chan AK, Mummaneni PV, Kidane J, Vargas E, et al. Are preoperative chlorhexidine gluconate showers associated with a reduction in surgical site infection following craniotomy? A retrospective cohort analysis of 3126 surgical procedures. J Neurosurg. 2021;135(6):1889-97. [Crossref]  [PubMed]  [PMC] 
  28. Prayugo B, Siregar A, Hutahaean L, Hasibuan M. The effectiveness of pre-operative bath with 4% chlorhexidine gluconate for prevention of surgical site infection at the universitas sumatera utara hospital. Open Access Macedonian Journal of Medical Sciences. 2022;10(G):233-7. [Crossref] 
  29. Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2015;2015(2):CD004985. [Crossref]  [PubMed]  [PMC] 
  30. WHO. Global Guidelines for the Prevention of Surgical Site Infection, second edition [Internet]. World Health Organization. Geneva; 2016. Available from: [Link] 
  31. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-91. Erratum in: JAMA Surg. 2017;152(8):803. [Crossref]  [PubMed] 
  32. Corby M, Meller C, Park S. Does perioperative skin preparation reduce surgical site infection? Laryngoscope. 2018;128(9):1987-9. [Crossref]  [PubMed] 
  33. Omolabake BI, Ozoila KN. A comparison of postoperative wound infection rates after preoperative hair removal with razors versus clippers in a sub-urban setting. International Surgery Journal. 2020;7(11):3627-32. [Crossref] 
  34. Varia DM, Kacheriwala S. Pre-operative shaving versus trimming and their relation to post operative surgical site infection (ssi), a randomized controlled trial. Journal of Medical Science And clinical Research. 2016;4(8):12272-7. [Link] 
  35. Grober ED, Domes T, Fanipour M, Copp JE. Preoperative hair removal on the male genitalia: clippers vs. razors. J Sex Med. 2013;10(2):589-94. [Crossref]  [PubMed] 
  36. Tanner J, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2021;8(8):CD004122. [Crossref]  [PubMed]  [PMC] 
  37. Jalalzadeh H, Groenen H, Buis DR, Dreissen YE, Goosen JH, Ijpma FF, et al. Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis. Lancet Microbe. 2022;3(10):e762-e71. Erratum in: Lancet Microbe. 2022;3(10):e732. [Crossref]  [PubMed] 
  38. Candan Dönmez Y. Ameliyat öncesi cilt hazırlığı [Preoperative skin preparation]. Türkiye Klinikleri J Surg Nurs-Special Topics. 2016;2(2):11-6. [Link] 
  39. Álvarez CA, Guevara CE, Valderrama SL, Sefair CF, Cortes JA, Jimenez MF, et al. Practical recommendations for preoperative skin antisepsis. Infectio. 2018;22(1):46-54. [Crossref] 
  40. Australasian College for Infection Prevention and Control. [Internet]. [Cited: February 14, 2024].Position Statement Preoperative Skin Antisepsis. 2019.
  41. Anggrahita T, Wardhana A, Sudjatmiko G. Chlorhexidine-alcohol versus povidone-iodine as preoperative skin preparation to prevent surgical site infection: a meta-analysis. Medical Journal of Indonesia. 2017;26(1):54-61. [Crossref] 
  42. Dumville JC, McFarlane E, Edwards P, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev. 2013;(3):CD003949. Update in: Cochrane Database Syst Rev. 2015;(4):CD003949. [Crossref]  [PubMed] 
  43. Elshamy E, Ali YZA, Khalafallah M, Soliman A. Chlorhexidine-alcohol versus povidone-iodine for skin preparation before elective cesarean section: a prospective observational study. J Matern Fetal Neonatal Med. 2020;33(2):272-6. [Crossref]  [PubMed] 
  44. Luwang AL, Saha PK, Rohilla M, Sikka P, Saha L, Gautam V. Chlorhexidine-alcohol versus povidone-iodine as preoperative skin antisepsis for prevention of surgical site infection in cesarean delivery-a pilot randomized control trial. Trials. 2021;22(1):540. [Crossref]  [PubMed]  [PMC] 
  45. Valappil RK, Sajesh PT, Krishnan S. Preoperative skin preparation with chlorhexidine alcohol and povidone iodine: a comparative study. Journal of Medical Science and Clinical Research. 2017;5(12):32071-5. [Crossref] 
  46. Haas DM, Morgan S, Contreras K, Kimball S. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev. 2020;4(4):CD007892. [Crossref]  [PubMed]  [PMC] 
  47. Fink K, Örgel M, Baier C, Brauckmann V, Giannoudis V, Liodakis E. Quality of lower limb preoperative skin preparation using colorless versus colored disinfectants-results of an experimental, randomized study in a close to reality setting. PLoS One. 2023;18(3):e0282662. [Crossref]  [PubMed]  [PMC] 
  48. The U.S. Food and Drug Administration [Internet]. [Cited: November 10, 2023]. FDA Drug Safety Communication: FDA requests label changes and single-use packaging for some over-the-counter topical antiseptic products to decrease risk of infection. 2013. Available from: [Link] 

.: Up To Date

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com