According to the National Healthcare Safety Network, surgical site infections (SSI) comprise roughly 20% of all healthcare-associated infections and correlate with a 2-to-11-fold mortality increase directly related to the SSI.¹ It is our duty as healthcare providers to decrease our patient’s mortality risks. Thankfully, there are measures we can take to ensure a decrease in the number of SSIs. Studies agree that there are several practices clinicians can utilize to decrease SSI risks. 

Preoperative measures:

Skin preparation

Preoperative showers utilizing chlorhexidine soap can reduce bacterial colonization. Patients should ensure washing of skin folds, axillae, and groin, and leave the chlorhexidine in place for at least 2 minutes prior to washing the day of the surgery.^2-3 

Due to microtrauma, hair removal utilizing a razor is not indicated prior to surgical incision. If hair removal is necessary, use of electric razors has shown lower incidence of SSI than utilization of razors or creams.^2-4 

Clinician scrub in procedures

Cleanliness is crucial as an operative clinician. Hand washing, artificial item removal, and initial daily wash utilizing a nail brush and antiseptic soap for at least 5 minutes can significantly reduce the risk of SSIs.⁵ 

Decolonization and prophylactic antibiotics

Colonization versus contamination is a major consideration in wound care, and understanding the difference is key. Colonization describes where the bacteria merely live, whereas contamination occurs when the bacteria are actively altering the wound environment. With a new surgical wound, an environment that was once colonized by bacteria preoperatively could invade the surgical wound, leading to contamination and SSI.³ 

Research shows that nasal mupirocin ointment is effective against the common bacteria staphylococcus aureus, which is a normal skin flora that can stall wounds and lead to SSIs.² Dermal and intranasal antistaphylococcal agents have also been approved for high-risk surgeries.³

In indicated procedures, SSI risks may successfully be reduced with prophylactic antibiotic therapy. Therapeutic concentrations should be met at the time of first incision. Typically, intravenous antibiotics will optimally be given 30 to 60 minutes before incision.² 

Glycemic control

As with wound care protocols, it is imperative that the surgical patient be in glycemic control to reduce SSI risk. Hyperglycemia has been linked to higher SSI rates in both diabetics and non-diabetics. Levels should be maintained at roughly 150-200 mg/dL. Levels under 150 can lead to hypoglycemia, which can lead to poor outcomes.² 

Nutritional optimization

Nutritional optimization is crucial in preventing SSIs. Malnourishment, which can also occur alongside obesity, can alter the healing process of wounds. It is recommended that patients be appropriately nourished before any surgical procedure. Protein, vitamin, and mineral deficiencies can delay the healing process.⁴

Intraoperative measures:

Skin antiseptics

Utilization of antiseptics in the surgical field may also decrease SSI risk. Specifically, 2% chlorhexidine alcohol solutions are thought to be more effective than povidone iodine solutions on undamaged skin pre-incision. Should the incision site be located on a previously open wound or mucosal site, water-based antiseptic with 2% chlorhexidine or 10% povidone iodine is recommended. Regardless of incision location, antiseptics should be allowed to sit for 3 minutes and air dry before surgical drape placement.²

Wound irrigation

Pressurized irrigation of the surgical wound bed prior to closure with any substance, including normal saline, has been shown to decrease the risk of SSI by removing foreign detritus.²

Surgical field contaminants

Sterile drapes and gowns can minimize bacterial contamination, but once they become wet, they lose their functionality. Clinicians should use disposable surgical caps, mouth, nose, and hair/head coverings. There is no evidence of decreased SSI incidence with double gloving, though it continues to be recommended for contamination prevention.² 

It is not recommended to cover the surgical field with adhesive clear plastic, as this can actually increase incidence of SSIs.² 

It is recommended that clinicians change surgical instruments as well as auxiliary materials prior to wound closure to decrease risk of contamination.² 

Postoperative measures:

Skin protection

Protection of the surgical site postoperatively is imperative to prevent SSIs. Waterproof physical barriers applied to the edge of the wound are shown to significantly reduce SSIs.² The wound should be protected with a sterile dressing that is not disturbed for 24-48 hours. Clinicians should also be to wash their hands prior to any contact with the dressing. Glue is not recommended for use as a surgical wound dressing.²

Negative pressure wound therapy

Negative pressure wound therapy has been correlated with a decrease in SSIs, particularly in cardiac and abdominal surgery as well as surgeries that pose a high risk for infection. ² 

Conclusion:

While SSIs remain a notable risk for all surgery patients, clinicians can improve outcomes by regularly undertaking numerous preventative measures before, during, and after surgery to reduce the likelihood of a surgical wound becoming contaminated.

References

1.     Centers for Disease Control and Prevention. Surgical Site Infection. Published 2025. Accessed July 28, 2025. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

2.     Badia J, Perez I, Manuel A, et al. Surgical site infection prevention measures in general surgery: position statement by the Surgical Infections Division of the Spanish Association of Surgery. Cir Esp (Engl Ed). 2020;98(4). doi:10.1016/j.cireng.2020.04.001

3.     Seidelman J, Mantyh C, Anderson D. Surgical site infection prevention: a review. JAMA. 2023;329(3). doi:10.1001/jama.2022.24075

4.     Wood A. Infection Prevention: A Perioperative Nurse’s Guide to Preventing Surgical Site Infections. Association of periOperative Registered Nurses; 2024. Accessed July 28, 2025. https://aorn.org/guides/infection-prevention-a-perioperative-nurses-guide

5.     Tanner J, Dumville JC, Norman G, Fortnam M. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database Syst Rev. 2016;2016(1):CD004288. Published 2016 Jan 22. doi:10.1002/14651858.CD004288.pub3