Abstract

SURGICAL SITE INFECTION (SSI): EVIDENCE-BASED PREVENTION STRATEGIES AND POSTOPERATIVE WOUND CARE – A LITERATURE REVIEW

Dr. Rahul Gasti*, Dr. Kubendra H. Pachchinavar, Dr. R. C. Yakkundi

Abstract

Background: Surgical site infection (SSI) is among the most prevalent postoperative complications and remains a significant cause of increased morbidity, prolonged hospital stay, unplanned re-interventions, excessive antimicrobial consumption, and substantial economic burden to healthcare systems. Although improvements in operative techniques, aseptic precautions, perioperative antimicrobial prophylaxis, and standardization of perioperative practices have reduced infection rates, SSIs continue to occur across all wound classes, including clean, clean-contaminated, contaminated, and dirty procedures. Contemporary evidence increasingly supports the implementation of comprehensive prevention bundles and structured postoperative wound care protocols to minimize SSI incidence and improve clinical outcomes. Objective: To critically review current evidence regarding the definition, classification, etiopathogenesis, risk factors, microbiological profile, and prevention strategies for SSI, with particular emphasis on evidence-based perioperative prevention bundles and postoperative wound care principles. Methods: A narrative review was undertaken using standard surgical literature and infection control resources, including clinical guidelines and peer-reviewed publications related to SSI. The review incorporated key domains such as SSI definitions and classification (superficial incisional, deep incisional, and organ/space SSI), patient- and procedure-related risk determinants, causative microorganisms with antimicrobial resistance patterns, and evidence-based preventive measures spanning the preoperative, intraoperative, and postoperative phases. Additionally, approaches to early diagnosis and structured postoperative wound management were synthesized to present a clinically applicable framework for SSI reduction. Results: The occurrence of SSI is multifactorial and influenced by host-related variables such as diabetes mellitus, obesity, anemia, malnutrition, smoking, and immunosuppression, as well as operative and environmental factors including prolonged operative duration, excessive tissue trauma, presence of foreign bodies or drains, perioperative hypothermia, suboptimal glycemic control, and breaches in sterile technique. The predominant pathogens implicated in SSI include Staphylococcus aureus (including methicillin-resistant strains) and gram-negative bacilli, with variation based on the operative site and degree of contamination. Evidence supports the effectiveness of prevention bundles comprising preoperative patient optimization, appropriate skin antisepsis, correctly timed antimicrobial prophylaxis, maintenance of normothermia and adequate oxygenation, strict adherence to asepsis, and standardized postoperative wound care protocols. Prompt recognition and management—including clinical wound evaluation, microbiological sampling, culture-guided antimicrobial therapy, and surgical interventions such as drainage or debridement when indicated—are essential to prevent progression to deep or organ/space infections. Conclusion: Surgical site infection continues to represent a major challenge in postoperative care. Implementation of evidence-based perioperative prevention bundles, supported by standardized postoperative wound care practices and early detection strategies, remains fundamental for effective SSI control. Strengthening adherence to infection prevention protocols and optimizing modifiable risk factors may significantly improve surgical outcomes and reduce SSI-related complications.

Keywords: Surgical site infection; SSI; postoperative wound care; infection prevention; antimicrobial prophylaxis; prevention bundle; asepsis; antimicrobial resistance.