Global Alliance for infections in Surgery bundle for the prevention of surgical site infections worldwide

Surgical site infections (SSIs) are associated with increased morbidity, increased duration of hospitalization, re-admission, and excess utilization of health care resources.

SSIs are the most common healthcare-associated infections among surgical patients. It is obviously important to improve patient safety by reducing the occurrence of surgical site infections. Despite progress in prevention knowledge SSIs remain one of the most common adverse events in hospitals. Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have recently published guidelines for the prevention of surgical site infections. Both new WHO and CDC guidelines are well designed, complete and appropriate from a methodological point of view and every surgeon worldwide should know them.

Despite evidence supporting the effectiveness of best practices, many surgeons fail to implement them, and evidence-based processes and practices that are known to reduce the incidence of SSIs tend to be underused in routine practice. However knowledge, attitude, and awareness of infection prevention and control measures among surgeons are often inadequate and a great gap exists between the best evidence and clinical practice with regards to SSIs prevention.

Numerous clinical interventions with varying levels of supporting evidence have been implemented to reduce SSIs. A recent approach to improving patient outcomes is the use of care bundles. The concept of a care bundle was developed from evidence documenting that a structured approach to performing 3–5 evidence-based collective interventions could lead to an improved patient outcome.

The Global Alliance for Infections in Surgery proposes 5 simple procedures for the prevention of SSIs that every hospital in every region of the world should respect in order to grant  patients an appropriate policy of best practices.

Preoperative bathing/showering: It is good clinical practice for patients to bathe or shower prior to surgery in order to ensure that the skin is as clean as possible and to reduce the bacterial load, especially at the site of incision. Either plain soap or an antiseptic soap may be used for this purpose.

Surgical antibiotic prophylaxis: When indicated (depending on the type of operation), surgical antibiotic prophylaxis should be administered prior to the surgical incision. Every hospital around the world should have a local protocol of surgical prophylaxis based on evidences from international guidelines, local epidemiology and available resources.

Hair removal: In patients undergoing any surgical procedure, hair should either not be removed or, if absolutely necessary, should be removed only with a clipper in operating room immediately before surgery.

Skin antiseptic preparation: Alcohol-based antiseptic solutions, should be used for surgical site skin preparation in patients undergoing surgical procedures.

Surgical hand scrub/ preparation: Surgical hand preparation should be performed accurately using either a suitable antimicrobial soap and water or a suitable alcohol-based hand rub before donning sterile gloves.

Respecting these 5 simple bundles, most surgical site infections could be prevented in the world.


Global guidelines on the prevention of surgical site infection

Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection


Global Alliance for Infections in Surgery17