Surgical site infection prevention bundles: a focus on preoperative skin decolonisation

Surgical and preoperative disinfection techniques have evolved over the centuries, from the birth of modern surgery in the early 19th century, to the first use of carbolic acid for disinfecting surgical incisions, helping to prevent surgical site infections in the 1890s, through the discovery of antibiotics in 1928, to the first whole eye and partial face transplant, which was performed in 2023 (Whitlock, 2024). These advances in surgery have led to improved surgical patient outcomes, reduced hospital length of stays and reduced incidences of avoidable infections. Sadly, these advancements are set against a rise in antimicrobial resistance and infectious diseases. This calls for urgent revolutionary strategies to tackle escalating threats to health care and humanity in general.

Published surgical site infection (SSI) guidelines that span the surgical pathway (preoperative skin preparation, appropriate surgical antibiotic prophylaxis, intraoperative practices and postoperative wound care and recovery), are available (Berríos-Torres et al, 2017; World Health Organization (WHO), 2018; National Institute for Health and Care Excellence (NICE), 2020). However, compliance with evidence-based recommendations or bundles has been reported to be poor or actions have not been recorded accurately.