Surgical site infections (SSIs) present a major clinical challenge, accounting for a significant proportion of postoperative complications across surgical disciplines. Their impact is far-reaching: extended hospital stays, delayed wound healing, increased costs, and in severe cases, higher morbidity and mortality.^1,2 For wound care professionals, whether in acute, outpatient, or long-term care settings, recognizing the causes of SSIs and the factors that put patients at increased risk can inform more effective prevention and management strategies.

SSIs are broadly classified as superficial, deep incisional, and organ/space infections, depending on the depth and extent of tissue involvement. These infections typically occur within 30 days post-operation—or within a year if prosthetic implants are used.^1,2 Understanding this classification system is vital for guiding both the clinical response and documentation protocols.

Understanding SSI Risk

Patient-related Risk Factors

Many risk factors can influence a patient’s susceptibility to infection at different stages of care. Patient-related factors such as diabetes, obesity, advanced age, malnutrition, and immunosuppression significantly elevate SSI risk.^1-3 These elements underscore the importance of holistic and comprehensive preoperative assessments, especially in identifying and modifying conditions that could compromise wound healing. For instance, optimizing glycemic control or addressing nutritional deficiencies can reduce infection risk substantially.¹

Procedure-related Risk Factors

Procedure-related factors also play a key role. Prolonged surgical duration increases the opportunity for contamination, while poor tissue handling or suboptimal hemostasis may lead to necrosis or hematoma formation, both of which create a favorable environment for microbial growth. The use of drains, while sometimes necessary, can also serve as a conduit for pathogens if not managed meticulously.^1-3 These intraoperative considerations reinforce the importance of technical precision and adherence to sterile protocols.

Environmental Risk Factors

The operating room environment itself is another critical factor. Air quality, traffic flow, and sterilization practices all influence microbial load.¹ Importantly, even the most rigorous infection control protocols can be undermined if prophylactic antibiotics are not administered within the correct timeframe or if inappropriate antimicrobial agents are selected. Additionally, the rise of antimicrobial-resistant organisms complicates the management of SSIs and highlights the need for antibiotic stewardship.¹

Intervening to Prevent SSI

To mitigate these risks, individual and teams should tailor their strategies to each phase of surgical care. During the preoperative phase, clinicians should focus on comprehensive risk assessments and patient optimization. This includes interventions like smoking cessation, glycemic control, nutritional support, and appropriate antibiotic prophylaxis ideally administered within one hour before incision. Preoperative bathing with chlorhexidine and hair removal with clippers rather than razors are simple yet effective steps that can also reduce bacterial burden.^1-2

Intraoperatively, meticulous technique and environmental vigilance are paramount. Surgeons should prioritize gentle tissue handling, maintain effective hemostasis, and minimize operative time when feasible. Infection control practices, such as proper draping and limiting room traffic, must be carefully followed to maintain a sterile field.¹ The presence of multidisciplinary teams, including perioperative nurses and infection prevention specialists, can help ensure these protocols are adhered to consistently.

Postoperatively, wound care providers become the frontline defense against SSI development. Vigilant monitoring for early signs of infection, including redness, warmth, swelling, discharge, or systemic symptoms, is essential.¹ Evidence-based dressing protocols should be followed, and patient education must not be overlooked. Patients should understand how to care for their incisions at home and when to seek help if complications arise. Post-discharge surveillance programs can also support early intervention and reduce readmission rates.^1,4

Thinking About SSIs Across the Care Continuum

Different care settings can tailor these strategies to their unique challenges and resources. In acute care hospitals, for example, formalized infection prevention programs and data-driven quality improvement initiatives are crucial. Surgical care bundles and regular audits can support compliance and identify gaps.^1,3 Outpatient surgical centers, on the other hand, benefit from streamlined processes and quick patient turnover, but must remain vigilant through effective follow-up systems and staff education. Meanwhile, long-term care facilities should prioritize continuity of care and establish communication channels with surgical teams to manage residents with recent procedures or existing wounds.¹

Ultimately, the prevention and management of surgical site infections is not the sole responsibility of surgeons or infection control teams, but it is a shared duty across the entire continuum of care. By recognizing the multifactorial nature of SSIs and embedding proactive measures into every phase of surgical care, wound care professionals can significantly improve outcomes, reduce complications, and ensure a higher standard of patient safety.

References:

1.        Bucataru A, Balasoiu M, Ghenea AE, Zlatian OM, Vulcanescu DD, Horhat FG, et al. Factors contributing to surgical site infections: a comprehensive systematic review of etiology and risk factors. Clinics and Practice. 2024; 14(1):52-68. doi:10.3390/clinpract14010006

2.        Zabaglo M, Leslie SW, Sharman T. Postoperative wound infections. [Updated 2024 Mar 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Accessed May 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560533/

3.        Ching PR. Care bundles in surgical site infection prevention: a narrative review. Curr Infect Dis Rep. 2024;26:163–172. doi:10.1007/s11908-024-00837-9

4.        Horgan S, Hegarty J, Drennan J, Keane D, Saab MM. The effect of interventions on the incidence of surgical site infections in acute care settings: a systematic review. J Tissue Viability. 2024;33(1):75-88. doi:10.1016/j.jtv.2023.11.004