Table 2. Selected Risk Factors for and Recommendations to
Prevent Surgical Site Infections (SSIs)
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.
NA
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.
NA
History of SSTIs No formal recommendation. History of a prior skin
infection may be a marker for inherent differences in
host immune function.
NA
Modifiable
Glucose control Control serum blood glucose levels for all surgical
patients, including patients without diabetes. For
patients with diabetes mellitus, reduce glycosolated
hemoglobin A1c levels to <7% before surgery, if
possible.
I
Obesity Increase dosing of prophylactic antimicrobial agent
for morbidly obese patients.
I
Smoking cessation Encourage smoking cessation within 30 days of
procedure.
I
Immunosuppressive
medications
Avoid immune-suppressive medications in
perioperative period, if possible.
III
Hypoalbuminemia No formal recommendation. Although a noted
risk factor, DO NOT delay surgery for use of total
parenteral nutrition.
NA
Extrinsic, procedure related (perioperative)
Preparation of patient
Hair removal DO NOT remove unless hair will interfere with
the operation. If hair removal is necessary, remove
outside the OR by clipping. DO NOT use razors.
II
Preoperative
infections
Identify and treat infections (eg, urinary tract
infection) remote to the surgical site prior to elective
surgery. DO NOT routinely treat colonization or
contamination.
II
Surgical Site Infections
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