By Dawn Whiteside
Perioperative nurses are at the center of patient care during surgical or other invasive procedures. A major aspect of patient safety during procedures is the prevention of surgical site infections (SSI). SSIs are the most common hospital-acquired infection (HAI), accounting for approximately 20% of all HAIs (Barnes, 2018). An SSI is defined as an infection that occurs after a surgical procedure in the body where surgery has taken place (APIC, n.d.). Numerous resources and evidence-based guidelines direct professional nursing practice, significantly impacting patient outcomes related to SSIs by reviewing current data trends and implementing perioperative standards of practice.
The most recent data from 2023 revealed a 3% increase in HAIs, affecting 1-3 people per 100 surgeries. Furthermore, 75% of patient deaths from HAIs are attributed to SSIs (APIC, 2024; NHSN, 2025). Beyond the significant impact on patient health, SSIs contribute to an estimated annual cost of $3.3 billion and an increase in hospital stays by approximately 9.7 days per admission (NHSN, 2025). According to the Centers for Disease Control (CDC), 50% of all SSIs are preventable (Barnes, 2018, p. 548). Effective SSI prevention requires collaboration among patients, providers, and regulatory agencies.
In 2006, the Centers for Medicare and Medicaid Services (CMS) introduced the Surgical Care Improvement Project (SCIP), marking the first national initiative to address deaths related to SSIs through preventative strategies. SCIP measures aimed at reducing SSIs include appropriate prophylactic antibiotic use (timing and selection), discontinuing antibiotics within 24-48 hours, preoperative hair removal using clippers, maintaining patient normothermia, and glycemic control during surgery (Edmiston et al., 2011).
The Association of periOperative Registered Nurses (AORN) publishes perioperative standards of practice and the Guidelines for Perioperative Practice, which outline SSI prevention strategies such as hand hygiene, sterile technique, environmental care, cleaning and disinfection, sterilization, and transmission-based precautions. Additionally, The Joint Commission (TJC) annually updates the National Patient Safety Goals (NPSGs) to prevent adverse outcomes. NPSG 7, “Reduce the risk of health care-associated infections,” specifically emphasizes adherence to hand hygiene guidelines established by the CDC and the World Health Organization (WHO) (NPSGs, 2025). Strict compliance with CMS, CDC, WHO, TJC, and AORN recommendations is essential for protecting patients and preventing SSIs.
Implementing evidence-based SSI prevention practices through perioperative standards requires personnel compliance with established guidelines. A global study highlighted that SSIs are a worldwide concern. A survey assessing knowledge levels categorized responses as good, fair, or moderate (Habtie et al., 2025). Among respondents, 46% demonstrated a good understanding of SSI prevention strategies, while 27% reported a fair or moderate level of knowledge (Habtie et al., 2025). Another study found that awareness of recommended SSI prevention guidelines ranged from 76.3%-96.6%, yet actual implementation varied between 40.4% and 93.4% (Aktas & Damar, 2022). Perioperative strategies for SSI prevention are critical throughout the continuum of care, as summarized in Table 1 (Habtie et al., 2025).
Perioperative nurses must not only possess knowledge of SSI risk reduction strategies but also implement these established guidelines. Without accountability for patient safety, SSIs will continue to negatively impact patient outcomes. As evidence and guidelines evolve, it is an ethical obligation for perioperative nurses to stay informed about recent literature and updates to ensure best practices in patient care.
Table 1
|
Perioperative Location |
Prevention Strategies |
|
Perioperative |
Identifying patient risk factors, administering appropriate antimicrobial prophylaxis, ensuring proper skin preparation. |
|
Intraoperative |
Adherence to strict aseptic techniques, wearing appropriate surgical attire, using sterile surgical drapes, performing antiseptic irrigation. |
|
Postoperative |
Proper wound care techniques, encouraging early mobilization, rational use of antibiotics. |
References:
Association for Professionals in Infection Control and Epidemiology (APIC). (n.d.). Frequently asked questions. https://apic.org/Resource_/TinyMceFileManager/Practice_Guidance/NNL_SSI.pdf, retrieved March 5, 2025.
Association for Professionals in Infection Control and Epidemiology (APIC). (2024). Study: Dangerous surgical stie infections can be reduced with simple prevention protocol. https://apic.org/news/study-dangerous-surgical-site-infections-can-be-reduced-with-simple-prevention-protocol/, retrieved March 6, 2025.
Barnes, S. (2018), Surgical Site Infection Prevention in 2018 and beyond. AORN J, 107: 547-550. https://doi.org/10.1002/aorn.12144
Edmiston, C. E., Jr., Spencer, M., Lewis, B. D., Brown, K. R., Rossi, P. J., Henen, C. R., Smith, H. W., & Seabrook, G. R. (2011). Reducing the risk of surgical site infections: did we really think SCIP was going to lead us to the promised land? Surgical Infections, 12(3), 169. https://doi.org/10.1089/sur.2011.036
Habtie, T. E., Feleke, S. F., Terefe, A. B., Alamaw, A. W., & Abate, M. D. (2025). Nurses’ knowledge and its determinants in surgical site infection prevention: A comprehensive systematic review and meta-analysis. PLoS ONE, 20(1), 1–17. https://doi.org/10.1371/journal.pone.0317887
National Healthcare Safety Network (NHSN). (2025). Chapter 9: Surgical site infection (SSI) event-January 2025. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf.
National Patient Safety Goals (NPSGs) effective January 2025. Hospital Accreditation Program. The Joint Commission. Accessed March 11, 2025.
