Surgical Site Infection Prevention and Management

Surgical site infections (SSIs) remain among the most frequent and costly complications of operative care, affecting superficial and deep tissues at the incision site. Their prevention spans preoperative, intra-operative and postoperative phases and involves patient optimisation, antimicrobial prophylaxis, skin antisepsis, maintenance of aseptic technique and targeted wound surveillance. Global studies have demonstrated higher SSI rates in low- and middle-income settings, driven by factors such as limited infrastructure, delayed antibiotic administration and variability in sterilisation practices. In high-income environments, attention has shifted towards evidence-based surgical bundles, precise timing and selection of antibiotic prophylaxis, chlorhexidine-alcohol skin preparation and judicious use of mechanical bowel preparation and oral antibiotics in colorectal surgery. Emerging strategies include machine-learning models for remote wound monitoring to expedite diagnosis and reduce clinician workload, and cost-effectiveness analyses that inform policy, particularly in resource-constrained health systems. Management of established SSIs combines targeted antimicrobial therapy guided by culture and sensitivity, timely surgical debridement when indicated, and standardised wound-care protocols. Attention to antimicrobial resistance, integration of perioperative bundles and adoption of digital health tools promise to refine SSI prevention and ensure equitable outcomes worldwide.

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Surgical Site Infection Prevention and Management publication trend

The graph below shows the total number of articles in surgical site infection prevention and management across all publications each year (not limited to Nature Index journals).

Technical terms

Surgical site infection (SSI): An infection occurring within 30 days of surgery at the incision or in deeper tissues.

Prophylactic antibiotic: A short-course antimicrobial administered before incision to prevent bacterial contamination.

Skin antisepsis: Preoperative preparation of the surgical field using agents such as chlorhexidine in alcohol.

Surgical bundle: A set of evidence-based interventions performed together to reduce SSI risk.

Machine-learning model: An algorithm trained on data sets, such as wound images and patient reports, to predict SSIs.

References

1. Multimodal machine learning to predict surgical site infection with healthcare workload impact assessment. npj Digital Medicine (2025).
2. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a model-based cost-effectiveness analysis of a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. The Lancet Global Health (2024).
3. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. The Lancet Infectious Diseases (2018).
4. Association of Mechanical Bowel Preparation and Oral Antibiotics Before Elective Colorectal Surgery With Surgical Site Infection. JAMA Network Open (2018).
5. The Forgotten Role of Alcohol: A Systematic Review and Meta-Analysis of the Clinical Efficacy and Perceived Role of Chlorhexidine in Skin Antisepsis. PLOS ONE (2012).