HAI Prevention - Surgical Site Infections

Surgical Site Infection (SSI) Prevention

Resources and Data

Healthcare-associated infections (HAIs) - Surgical site infections (SSIs)

SSIs are infections that occur after surgery, in the area of the body where the procedure took place. SSIs are currently the most frequently reported serious HAIs among Wisconsin hospitals. Many hospitals and quality improvement organizations are working together to reduce these infections. The Division of Public Health provides frequently updated SSI data to monitor statewide progress toward SSI reduction.

Data and statistics

Wisconsin SSI Data - Quarter 4, 2014
Number of hospitals reporting = 99

Data accessed from the National Healthcare Safety Network (NHSN) on May 14, 2015.

Infections following all reported procedures Total procedures performed

Wisconsin standardized infection ratio (SIR)






(Number of observed infections divided by the number of predicted infections based on national data.)

* Statistically significantly lower than the national baseline, but not significantly different from last year at this time.

Prevention resources

Journal references - Last updated: May 15, 2015

Antimicrobial Prophylaxis - Weight-based Dosing

  • Bratzler D, Dellinger E, Olsen K, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm 2013;70:195-283.
  • Edmiston CE, Krepel C, Kelly H, et al. Peri-operative antimicrobial prophylaxis in the gastric bypass patient: Do we achieve therapeutic levels? Surgery 2004;136:738-747.
  • Pevzner L, Swank M, Krepel C, et al. Effect of maternal obesity on tissue concentration of prophylactic cefazolin during cesarean section. Obstet Gynecol 2011;117:877-882.

Antimicrobial Wound Closure

  • Daoud FC, Edmiston CE, Leaper D. Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: Robustness to new evidence. Surgical Infect 2014;15(3):165-181.
  • Edmiston CE, Daoud FC, Leaper D. Is there an evidence-based argument for embracing an antimicrobial (triclosan)-coated suture technology to reduce the risk for surgical-site infections? A meta-analysis. Surgery 2013;154:89-100.
  • Edmiston CE, Krepel CJ, Marks RM, et al. Microbiology of explanted suture segments from infected and noninfected surgical patients. J Clin Microbiol 2013;51:417.
  • Edmiston CE, Seabrook GR, Cambria RA, et al. Molecular epidemiology of microbial contamination in the operating room environment: Is there a risk for infection? Surgery 2005;138:573-582.
  • Edmiston CE, Seabrook GR, Goheen MP, et al. Bacterial adherence to surgical sutures: Can antibacterial-coated sutures reduce the risk of microbial contamination? J Am Coll Surg 2006;203:481-489.
  • Kathju S, Nistico L, Hall-Stoodley L, et al. Chronic surgical site infection due to suture-associated polymicrobial biofilm. Surgical Infect 2009;10:457-461.
  • Singh A, Bartsch SM, Muder RR, Lee BY. An economic model: Value of antimicrobial-coated sutures to society, hospitals, and third-party payers in preventing abdominal surgical site infections. Infect Control Hosp Epidemiol 2014;35:1013-1020.

CHG Shower

  • Darouiche RO, Wall MJ, Itani KM. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362:18-26.
  • Denton GW. Chlorhexidine. In: Block SS, editor. Disinfection, Sterilization, and Preservation. 4th Ed. Media, PA: Lea & Febiger, Williams & Wilkins; 1991. p. 279.
  • Edmiston CE, Assadian O, Spencer M, et al. To bathe or not to bathe with chlorhexidine gluconate: Is it time to take a stand for preadmission bathing and cleansing? AORN J 2015;101:529-538.
  • Edmiston CE, Krepel CJ, Edmiston SE, et al. The preoperative shower revisited: Can high topical antiseptic levels be achieved on the skin surface prior to surgical admission? J Am Coll Surg 2008;207:233-239.
  • Edmiston CE, Krepel CJ, Edmiston SE, et al. Reducing the risk of surgical site infections: Does chlorhexidine gluconate provide a risk reduction benefit? Am J Infect Control 2013;41:S49-S55.
  • Edmiston CE, Krepel CJ, Edmiston SE, et al. Empowering the surgical patient: A randomized, prospective analysis of an innovative strategy for improving patient compliance to the preadmission showering protocol. In Press: J Am Coll Surg, 2014.
  • Edmiston CE, Okoli O, Graham MB, et al. Improving surgical outcomes: An evidence-based argument for embracing a chlorhexidine gluconate (CHG) pre-operative shower (cleansing) strategy for elective surgical procedures. AORN J 2010;92:509-518.
  • Edmiston CE, Seabrook GR, Johnson CJ, et al. Comparison of a new and innovative 2% chlorhexidine impregnated cloth with 4% chlorhexidine as topical antiseptic for preparation of the skin prior to surgery. Am J Infect Control 2007;35:89-96.
  • Eiselt D. Presurgical skin preparation with a novel 2% chlorhexidine gluconate cloth reduces rates of surgical site infection in orthopaedic surgical patients. Orthopedic Nurs 2009;28:141-145.
  • Larson E. Guideline for use of topical antimicrobial agents. Am J Infect Control 1988;16(6):253-265.
  • Lipke VL, Hyott AS. Reducing surgical site infections by bundling multiple risk reduction strategies and active surveillance. AORN J 2010;92:288-296.
  • Mangram AJ, Horan TC, Pearson ML, et al. Guidelines for the prevention of surgical site infections. Infect Control Hosp Epidemiol 1999;27:97-134.
  • Paulson D. Efficacy evaluation of a 4% chlorhexidine gluconate as a full-body shower wash. Am J Infect Control 1993;21:205-209.

CHG Wound Irrigation

  • Barnes S, Spencer M, Graham D, Johnson HB. Surgical wound irrigation: A call for evidence-based standardization of practice. Am J Infect Control 2014;42:525-529.
  • Edmiston CE, Krepel CJ, Edmiston SE, et al. Reducing the risk of surgical site infections: Does chlorhexidine gluconate provide a risk reduction benefit? Am J Infect Control 2013;41:S49-S55.
  • Genuit T, Bochicchio G, Napolitano LM, et al. Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients. Surg Infect 2001;2:5.
  • Lim KS, Kam PCA. Chlorhexidine – pharmacology and clinical applications. Anaest Intensive Care 2008;36(4):502-512.
  • McDonnell G, Russell AD. Antiseptics and disinfectants: Activity, action, and resistance. Clin Microbiol Rev 1999;12:147.

Colon Surgery Bundle

  • Walts S, Fritze D, Banerjee M, et al. Developing an argument for bundled interventions to reduce surgical site infection in colorectal surgery. Surgery 2014;4:602-06.

Guideline Evaluation

HAI Prevalence Data

  • Magill SS, Edwards JR, Bamberg W, et al. Multistate point prevalence survey of healthcare-associated infections. N Engl J Med 2014;370:1198-1208.

MRSA Surveillance/Decolonization

  • Jarvis WR, Jarvis AA, Chinn RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010. Am J Infect Control 2012;40:194-200.
  • Kim DH, Spencer M, Davidson SM, et al. Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopedic surgery. J Bone Joint Surg Am 2010;92:1820-1826.

Prevention Measures Beyond SCIP

  • Edmiston CE, Spencer M, Lewis BD, et al. Reducing the risk of surgical site infections: Did we really think that SCIP would lead us to the promised land? Surgical Infect 2011;12:169-177.
  • Hawn MT, Vick CC, Richman J, et al. Surgical site infection prevention: Time to move beyond the surgical care improvement program. Ann Surg 2011;254:494-501.

Surgical Care Bundle Impact

  • Le C, Guppy KH, Axelrod YV, Hawk MW, Silverthorn J, Inacio MC, Akins PT. Lower complication rates for cranioplasty with peri-operative bundle. Clin Neurol Neurosurg. 2014 May;120:41-4, doi: 10.1016/j.clineuro.2014.02.009. Epub 2014 Feb 25
  • Leaper DJ, Tanner J, Kieman M, Assadian O, Edmiston CE Jr. Surgical site infection: Poor compliance with guidelines and care bundles. Int Wound J. 2014 Feb 25. doi.: 10.111/iwj.12243. [Epub ahead of print] 


Gwen Borlaug, Infection Control Epidemiologist
Wisconsin Division of Public Health 
Bureau of Communicable Diseases
Phone 608-267-7711
Fax 608-261-4976

Last Revised: June 12, 2015