title: Reducing the risk of surgical site infections: did we really think SCIP was going to lead us to the promised land?
abstract: BACKGROUND
  Surgical site infections (SSIs) are associated with substantial patient morbidity and death. It is estimated that 750,000-1 million SSIs occur in the U.S. each year, utilizing 3.7 million extra hospital days and costing more than $1.6 billion in excess hospital charges.
  
  
  METHODS
  Review of pertinent English-language literature.
  
  
  RESULTS
  The Surgical Care Improvement Project (SCIP) was embraced as a "one-size-fits-all" strategy to reduce postoperative infectious morbidity 25% by 2010. Unfortunately, the evidence suggests that SCIP by itself has had little efficacy in reducing the overall risk of SSI. Whereas the SCIP initiative represents a first national effort to focus on reducing postoperative infectious morbidity and deaths, it fails to consider salient risk factors such as body mass index and selected surgical practices, including tourniquet application prior to incision.
  
  
  CONCLUSIONS
  Rather than focus on a single risk-reduction strategy, future efforts to improve surgical outcomes should embrace a "SCIP-plus" multi-faceted, tiered interventional strategy that includes pre-admission antiseptic showering, state-of-the-art skin antisepsis, innovative antimicrobial technology, active staphylococcal surveillance, and pharmacologic-physiologic considerations unique to selective patient populations.
authors.affiliation: Surgical Microbiology Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. edmiston@mcw.edu
authors.forename: Charles E
authors.initials: CE
authors.lastname: Edmiston
authors.forename: Maureen
authors.initials: M
authors.lastname: Spencer
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lewis
authors.forename: Kellie R
authors.initials: KR
authors.lastname: Brown
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Rossi
authors.forename: Cindy R
authors.initials: CR
authors.lastname: Henen
authors.forename: Heidi W
authors.initials: HW
authors.lastname: Smith
authors.forename: Gary R
authors.initials: GR
authors.lastname: Seabrook
mesh_terms: D017408:Guidelines as Topic; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D014481:United States