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Systematic review and evidence-based guidance on perioperative antibiotic prophylaxisTECHNICAL REPORTPAP modalities supported by high- and moderate-quality studies were ranked first, followed by those supported bylow-quality studies. Only the 10 modalities ranked highest were retained; lower-ranking modalities were discarded.2.2 Key PAP modalities: indicators and barriers toimplementationIn three one-day consensus workshops, an expert group ranked and narrowed down the 10 PAP modalities to five.The experts developed a consensus-based guidance on key modalities and defined quality indicators for PAP. Thenames of the expert group members, their institutional affiliations and their areas of expertise are provided above;Figure 1 gives an overview of the process.Figure 1. Flowchart: developing five key modalities for PAPSystematic review:generation of basic key modalitiesFirst expert meeting: evidence and expert opinion, 10 key modalitiesSecond expert meeting: reduction to 5 key modalitiesThird expert meeting: agreement about appropriate indicators and EUwideapplicability for the five selected key modalities2.2.1 First expert meetingThe goal of the first expert meeting in Berlin was to review the results of the systematic review and to review theexperts’ scores of the 10 PAP modalities. Prior to the meeting, the experts had received the systematic review andthe results, the 10 PAP modalities and an evaluation form, which allowed them to score the 10 PAP modalities onquality of evidence, EU-wide applicability and implementability. The 10 modalities were then further broken downinto 15 questions or components, so that each item could be clearly described and scored individually, thusminimising the risk of misinterpreting the individual components of each PAP modality 4 .2.2.2 Second expert meetingThe second expert meeting was also held in Berlin. The aim was to narrow down the 10 PAP modalities to five byranking them according to quality of evidence and assessing their EU-wide applicability.Before the second meeting, the experts received a questionnaire with the 10 agreed-upon PAP modalities (Table20) from the first meeting and were asked to score them again (Table 21). The submitted scores were thenpresented at the second meeting. Each modality was discussed individually and was ranked according to theexperts’ score. Consensus was achieved by unanimous agreement on the five final key PAP modalities.2.2.3 Third expert meetingThe third expert meeting was held in Stockholm. The aim was to develop five quality-of-care indicators for themonitoring of the implementation of the five PAP modalities and to identify barriers for EU-wide applicability.Selection of quality indicators4 Further information is available upon request. See p. ii for details.10