title: An update on modifiable factors to reduce the risk of surgical site infections.
abstract: BACKGROUND
  Despite an increase in physician and public awareness and advances in infection control practices, surgical site infection (SSI) remains to be one of the most common complications after an operation. Surgical site infections have been shown to decrease health-related quality of life, double the risk of readmission, prolong the length of hospital stay, and increase hospital costs.
  
  
  OBJECTIVE
  To critically evaluate the literature and identify modifiable factors to reduce the risk of SSI.
  
  
  METHODS
  Systematic review of the literature.
  
  
  METHODS
  A critical review of the literature was performed using OVID, Pubmed, and the Cochrane database and focused on eight identifiable factors: preoperative screening and decolonization of methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus protocols, antiseptic showers, antiseptic cloths, perioperative skin preparation, surgeon hand hygiene, antibiotic irrigation and/or use of vancomycin powder, closed suction drains, and antibiotic suture.
  
  
  RESULTS
  Screening protocols have shown that 18% to 25% of patients undergoing elective orthopedic surgery are nasal carriers of S. aureus and that carriers are more likely to have a nosocomial infection and SSI. The evidence suggests that an institutionalized prescreening program, followed by an appropriate eradication using mupirocin ointment and chlorhexidine soap/shower, will lower the rate of nosocomial S. aureus infections. Based on the current literature, definitive conclusions cannot be made on whether preoperative antiseptic showers effectively reduce the incidence of postoperative infection. The use of a chlorhexidine bathing cloth before surgery may decrease the risk of SSI. There is no definitive clinical evidence that one skin preparation solution effectively lowers the rate of postoperative infection compared with another. The use of dilute betadine irrigation or vancomycin powder in the wound before closure likely decreases the incidence of SSI.
  
  
  CONCLUSIONS
  There is strong evidence in the literature that optimizing specific preoperative, intraoperative, and postoperative variables can significantly lower the risk of developing an SSI.
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St, Suite 1350, Chicago, IL 60611, USA. Electronic address: jsavage@nmff.org.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Savage
authors.forename: Paul A
authors.initials: PA
authors.lastname: Anderson
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000379:methods*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*
keywords: Complications; Spine; Surgical site infection