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Adjunctive measures for prevention of surgical site infection in adults

Deverick J Anderson, MD, MPH
Daniel J Sexton, MD
Section Editor
Anthony Harris, MD, MPH
Deputy Editors
Elinor L Baron, MD, DTMH
Kathryn A Collins, MD, PhD, FACS


Surgical site infections (SSIs) are a common cause of healthcare-associated infection [1-3]. The United States Centers for Disease Control and Prevention (CDC) has developed criteria that define SSI as infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the procedure or within one year if an implant is left in place [1,2]. SSIs are often localized to the incision site but can also extend into deeper adjacent structures. (See "Antimicrobial prophylaxis for prevention of surgical site infection in adults", section on 'Definitions'.)

Among surgical patients, SSIs are the most common nosocomial infection, accounting for 38 percent of nosocomial infections. It is estimated that SSIs develop in 2 to 5 percent of the more than 30 million patients undergoing surgical procedures each year (ie, 1 in 24 patients who undergo inpatient surgery in the United States has a postoperative SSI) [1,2].

The Institute for Healthcare Improvement and the Surgical Care Improvement Project have promoted a number of interventions to improve patient care and prevent avoidable deaths [4]. These include several interventions for reducing the incidence of SSIs discussed in the following sections. In one report, hospitals that instituted programs for appropriate use of antibiotics, approach to hair removal, glucose management, and thermoregulation reported a mean 27 percent reduction in SSI rates over one year (from 2.3 to 1.7 percent) [5]. In another study including more than 400,000 surgical patients, those who received at least two of the above measures had lower rates of SSI (adjusted odds ratio [aOR] 0.85, 95% CI 0.74-0.95) [6].

Antimicrobial prophylaxis is an important intervention for prevention of SSI; it is discussed in detail separately. Adjunctive measures for prevention of SSI will be reviewed here. (See "Antimicrobial prophylaxis for prevention of surgical site infection in adults".)


The most important factors in the prevention of surgical site infection (SSI) are careful attention to operative technique and timely administration of effective preoperative antibiotics.


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