Surgical site infections and their prevention.
OBJECTIVE
Recent studies have assessed interventions and bundles of interventions to prevent surgical site infections (SSIs). We reviewed numerous studies to identify those with the strongest evidence supporting interventions for preventing SSIs.


RESULTS
Bundles that included more than one intervention to decrease the risk of Staphylococcus aureus wound contamination, such as chlorhexidine bathing and nasal application of mupirocin, had the strongest supporting evidence. However, bundles should be tested to ensure that their components are not antagonistic. Vancomycin prophylaxis and extended antimicrobial prophylaxis should not be used routinely, but should be reserved for high-risk populations such as patients who carry methicillin-resistant S. aureus (MRSA). Novel interventions to prevent SSIs (e.g., topical or oral antimicrobial agents, skin sealant, and antimicrobial sutures) need further evaluation before surgeons implement them routinely.


CONCLUSIONS
There is some evidence that bundled interventions can reduce SSIs. However, more research should be done evaluating the effectiveness of these interventions. Future studies of bundles should use robust methodologies, such as randomized controlled trials, cluster randomized trials, or quasi-experimental studies analyzed by time series analysis.
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Marin L
ML
Schweizer
Loreen A
LA
Herwaldt
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D000985:Antisepsis / Q000379:methods; D004359:Drug Therapy, Combination / Q000379:methods; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D011300:Preoperative Care; D013203:Staphylococcal Infections / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents