Updated Recommendations for Control of Surgical Site Infections

J. Wesley Alexander, MD, ScD; Joseph S. Solomkin, MD; Michael J. Edwards, MD


Annals of Surgery. 2011;253(6):1082-1093. 

In This Article


Using the principles and guidelines outlined in this review, it should be able to reduce wound infections in major clean operative procedures to less than 0.5%, in clean contaminated cases to less than 1.0% and in contaminated cases to less than 2.0%, even in high-risk patients. A checklist may be helpful to achieve compliance.


1. The guidelines provided by the CDC and accrediting agents such as JACO have been followed. These include effective techniques for asepsis, air handling, cleaning of environmental surfaces, sterilization techniques, activities of surgical team members and surgical attire.

2. All members of the operative team have double gloved and changed gloves when any perforation is identified. Gowns and drapes have been used which prevent liquid penetration.

3. Preoperative showering with chlorhexidine within a few hours of the operation and the night before has been done and preoperative cleansing of the operative site with a chlorexidine-impregnated cloth just before entering the operating room.

4. When hair removal is done, clippers have been used shortly before operation.

5. Reduction of skin organisms of both the surgical team and patient have been done using a combination of alcohol and chlorhexidine although other effective products including alcohol with iodophors are acceptable.

6. An antimicrobial incise drape has been used at operative sites where it is technically feasible to get good adherence to the skin.

7. Suture material has been selected which resists infection.

8. Dead spaces have been obliterated, where possible.

9. Minimal trauma to the wound itself by gentle handling of tissues and limited use of electrocautery has been accomplished and all devitalized tissue has been removed.

10. Conduit drains and drainage through a working incision have not been used.

11. Prophylactic topical antibiotics such as 0.1% kanamycin or another aminoglycoside (eg, gentamicin 160 mg/500 mL) solution have been used vigorously by pressure irrigation several times during an operation and before closure in all but the simplest cases to remove clots and devitalized tissues and to ensure high-tissue levels of antibiotic. In patients with a subcutaneous fat layer greater than 3 inches in depth, antibiotics have been infused into the wound after closure by means of a small catheter with removal of the fluid by closed suction drainage after dwelling for a few hours.

12. Prophylactic systemic antibiotics have been used according to guidelines in all surgical cases where the incidence of infections exceeds approximately 0.5% or when any foreign body is implanted.

13. Core temperature has been maintained at 36°C or higher throughout the perioperative period.

14. Inspired oxygen has been given at a sufficient concentration to maintain subcutaneous oxygen concentrations of approximately 100 mm Hg and pulse oxygen readings above 96.

15. All diabetic and hyperglycemic patients have received tight glucose control (blood glucose <180 mg/dL) during the perioperative period and for 2 to 3 days afterward in high-risk patients.

16. Transfusion of blood products has been limited.

17. Patients have stopped smoking for at least 4 weeks before operation for highly elective procedures, such as abdominoplasty.


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