title: Alternatives to antibiotics for prevention of surgical infection.
abstract: BACKGROUND
  Surgical-site infection (SSI) is still the second most common healthcare-associated infection, after respiratory tract infection. SSIs are associated with higher morbidity and mortality rates, and result in enormous healthcare costs. In the past decade, several guidelines have been developed that aim to reduce the incidence of SSI. Unfortunately, there is no consensus amongst the guidelines, and some are already outdated. This review discusses the recent literature regarding alternatives to antibiotics for prevention of SSI.
  
  
  METHODS
  A literature search of PubMed/MEDLINE was performed to retrieve data on the prevention of SSI. The focus was on literature published in the past decade.
  
  
  RESULTS
  Prevention of SSI can be divided into preoperative, perioperative and postoperative measures. Preoperative measures consist of showering, surgical scrubbing and cleansing of the operation area with antiseptics. Perioperative factors can be subdivided as: environmental factors, such as surgical attire; patient-related factors, such as plasma glucose control; and surgical factors, such as the duration and invasiveness of surgery. Postoperative measures consist mainly of wound care.
  
  
  CONCLUSIONS
  There is a general lack of evidence on the preventive effectiveness of perioperative measures to reduce the incidence of SSI. Most measures are based on common practice and perceived effectiveness. The lack of clinical evidence, together with the stability of the high incidence of SSI (10 per cent for colorectal procedures) in recent decades, highlights the need for future research.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.
authors.forename: I B M
authors.initials: IB
authors.lastname: Ploegmakers
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.|Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, University College London, London, UK.
authors.forename: S W M
authors.initials: SW
authors.lastname: Olde Damink
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.
authors.forename: S O
authors.initials: SO
authors.lastname: Breukink
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001494:Baths; D002983:Clinical Competence; D004322:Drainage; D006235:Hand Disinfection; D006801:Humans; D017053:Infection Control / Q000379:methods; D054843:Negative-Pressure Wound Therapy; D009873:Operating Rooms; D061646:Operative Time; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D012307:Risk Factors; D017592:Skin Care; D058257:Surgical Attire; D013530:Surgical Wound Infection / Q000517:prevention & control*; D007507:Therapeutic Irrigation; D065227:Transfusion Reaction; D058106:Wound Closure Techniques
chemical_list: D000891:Anti-Infective Agents, Local