6
Recommendations
Table 2. Selected Risk Factors for and Recommendations
to Prevent SSI
Risk Factor Recommendation
Quality of
Evidence
Intrinsic, patient-related (preoperative)
Unmodifiable
Age No formal recommendation. Relationship
to increased risk of SSI may be secondary to
comorbidities or immunosenescence.
N/A
History of radiation No formal recommendation. Prior irradiation at the
surgical site increases the risk of SSI, likely due to
tissue damage and wound ischemia.
N/A
History of skin
and soft-tissue
infections
No formal recommendation. History of a prior skin
infection may be a marker for inherent differences in
host immune function.
N/A
Modifiable
Glucose control Control serum blood-glucose levels for all surgical
patients including patients without diabetes.
H
Obesity Increase dosing of prophylactic antimicrobial agent
for morbidly obese patients.
H
Smoking cessation Encourage smoking cessation within 30 days of
procedure.
H
Immunosuppressive
medications
Avoid immune-suppressive medications in
perioperative period if possible.
L
Hypoalbuminemia No formal recommendation. Though a noted
risk factor, do not delay surgery for use of total
parenteral nutrition.
N/A
S. aureus nasal
colonization
Decolonize patients with nasal mupirocin or
povidine-iodine prior to surgery.
M
Preparation of patient
Hair removal Do not remove unless hair will interfere with the
operation; if hair removal is necessary, remove
outside of the operating room by clipping. Do not
use razors.
H
Preoperative
infections
Identify and treat infections remote to the
surgical site (e.g., urinary tract infection prior to
elective surgery). Do not routinely test or treat
for asymptomatic bacteriuria except in urologic
procedures.
M
