An In-Depth Review of Surgical Site Infection Prophylaxis: Best Practices and Emerging Strategies

Abstract

Surgical site infections (SSIs) are a leading cause of post-operative morbidity, mortality, and increased healthcare costs worldwide. These infections, which can affect the surgical site's superficial, deep, or organ-space layers, complicate recovery, prolong hospital stays, and often necessitate additional treatments. Effective prophylaxis is crucial in preventing SSIs, improving surgical outcomes, and reducing the burden on healthcare systems. This review provides an overview of current best practices, evidence-based guidelines, and emerging strategies in SSI prevention. The pathophysiology of SSIs is influenced by a variety of factors, including microbial pathogens such as Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, as well as host factors like comorbidities (e.g., diabetes, obesity), immune function, and the surgical environment. Preoperative risk assessment through tools such as the ASA classification and wound categorization is essential for identifying high-risk patients and customizing prophylactic strategies. Standard prophylaxis includes timely antibiotic administration, optimal skin antisepsis (e.g., chlorhexidine, iodine solutions), glycemic control, and adequate nutrition to support immune function and wound healing. Intraoperative measures, such as maintaining sterile techniques and minimizing surgery time, are critical to reducing infection risk. Post-operatively, wound care, early mobilization, and judicious antibiotic use are crucial to promoting recovery and preventing complications. Emerging strategies include advanced antiseptic agents, probiotics for microbiome modulation, and antimicrobial-coated sutures and dressings. Guidelines from institutions such as the CDC, WHO, and NICE provide evidence-based frameworks for SSI prevention. However, ongoing debates on optimal antibiotic duration and the role of probiotics persist. Future research may focus on personalized prophylactic strategies based on genetic, microbiome, and risk profiling and initiatives to improve SSI prevention in resource-limited settings. This review emphasizes the importance of a multidisciplinary, evidence-based approach to SSI prevention, integrating current practices with emerging innovations.