# Modern Surgical Site Infection Prevention: Evidence, Gaps, and Future Directions

## TL;DR

This paper reviews current strategies to prevent surgical site infections, highlighting effective measures and future directions amid rising antibiotic resistance.

## Contribution

The paper synthesizes current evidence and identifies gaps in surgical site infection prevention strategies.

## Key findings

- Multimodal prevention across the perioperative pathway is essential for reducing surgical site infections.
- Antimicrobial sutures and host-directed immunomodulation show promise in targeted infection prevention.
- Persistent challenges include implementation barriers and the rise of multidrug-resistant organisms.

## Abstract

Surgical site infections (SSIs) remain among the most consequential and costly complications in surgery. Their persistence reflects the expanding threat of multidrug-resistant (MDR) organisms and the practical limits of even increasingly data-driven, systems-level prevention programs. Contemporary prevention is multimodal across the perioperative pathway. Preoperatively, patient optimization is central, and foundational measures include alcohol-based skin antisepsis, nutritional support, smoking cessation, and strict glycemic control. Intraoperatively, the emphasis shifts to technical precision and physiologic stability, including gentle tissue handling, maintenance of normothermia, appropriate oxygenation, and disciplined operating-room traffic. In parallel, material science and precision medicine are reshaping the armamentarium: antimicrobial sutures and surface coatings, host-directed immunomodulation, and personalized, risk-adapted strategies offer targeted protection. This narrative review synthesizes current evidence across these domains. We aim to clarify which measures carry the strongest support, identify persistent gaps and implementation challenges, and outline priorities for future research and practice.