The Surgical Site Infection (SSI) Toolkit addresses measures TEMP 01, 02, and 03, and GLU 01.  


The Surgical Site Infection (SSI) toolkit encompasses ASPIRE Measures TEMP 01, TEMP 02, TEMP 03 and GLU 01 with a focus on best avoiding surgical site infections, orthopedic and general surgery.  This toolkit is designed to meet the following objectives:

  • Define surgical site infection classifications and related pathophysiology
  • Discuss risks and outcomes associated with surgical site infections (SSIs)
  • Provide overview of anesthesia related elements in the SSI Prevention Bundle
  • Describe ASPIRE measures supporting SSI prevention 
  • Summarize recommendations based on literature presented


Additional SSI Resources


  1. WHO Guidelines Approved by the Guidelines Review Committee. Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization (c) World Health Organization 2018.; 2018.
  2. Alexander JW, Solomkin JS, Edwards MJ. Updated recommendations for control of surgical site infections. Annals of surgery. 2011;253(6):1082-1093.
  3. Alizo G, Onayemi A, Sciarretta JD, Davis JM. Operating Room Foot Traffic: A Risk Factor for Surgical Site Infections. Surgical infections. 2019;20(2):146-150.
  4. Allegranzi B, Zayed B, Bischoff P, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. The Lancet Infectious diseases. 2016;16(12):e288-e303.
  5. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection control and hospital epidemiology. 2014;35 Suppl 2:S66-88.
  6. Andersson AE, Bergh I, Karlsson J, Eriksson BI, Nilsson K. Traffic flow in the operating room: an explorative and descriptive study on air quality during orthopedic trauma implant surgery. American journal of infection control. 2012;40(8):750-755.
  7. Ban KA, Minei JP, Laronga C, et al. Executive Summary of the American College of Surgeons/Surgical Infection Society Surgical Site Infection Guidelines-2016 Update. Surgical infections. 2017;18(4):379-382.
  8. Banz VM, Jakob SM, Inderbitzin D. Review article: improving outcome after major surgery: pathophysiological considerations. Anesthesia and analgesia. 2011;112(5):1147-1155.
  9. Baum ML, Anish DS, Chalmers TC, Sacks HS, Smith H, Jr., Fagerstrom RM. A survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against further use of no-treatment controls. The New England journal of medicine. 1981;305(14):795-799.
  10. Belda FJ, Aguilera L, Garcia de la Asuncion J, et al. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. Jama. 2005;294(16):2035-2042.
  11. Berrios-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA surgery. 2017;152(8):784-791.
  12. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surgical infections. 2013;14(1):73-156.
  13. Clarke RS. The hyperglycaemic response to different types of surgery and anaesthesia. British journal of anaesthesia. 1970;42(1):45-53.
  14. Dellinger EP, Hausmann SM, Bratzler DW, et al. Hospitals collaborate to decrease surgical site infections. American journal of surgery. 2005;190(1):9-15.
  15. Duggan EW, Carlson K, Umpierrez GE. Perioperative Hyperglycemia Management: An Update. Anesthesiology. 2017;126(3):547-560.
  16. Edmiston CE, Jr., Bruden B, Rucinski MC, Henen C, Graham MB, Lewis BL. Reducing the risk of surgical site infections: does chlorhexidine gluconate provide a risk reduction benefit? American journal of infection control. 2013;41(5 Suppl):S49-55.
  17. Farrokhi F, Smiley D, Umpierrez GE. Glycemic control in non-diabetic critically ill patients. Best practice & research Clinical endocrinology & metabolism. 2011;25(5):813-824.
  18. Greif R, Akca O, Horn EP, Kurz A, Sessler DI. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. The New England journal of medicine. 2000;342(3):161-167.
  19. Hasselgren PO, Ivarsson L, Risberg B, Seeman T. Effects of prophylactic antibiotics in vascular surgery. A prospective, randomized, double-blind study. Annals of surgery. 1984;200(1):86-92.
  20. Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infection control and hospital epidemiology. 2008;29(11):996-1011.
  21. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infection control and hospital epidemiology. 1992;13(10):606-608.
  22. Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S. Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. Journal of cardiac surgery. 2005;20(5):403-407.
  23. Jonsson K, Jensen JA, Goodson WH, 3rd, et al. Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. Annals of surgery. 1991;214(5):605-613.
  24. Joshi GP, Chung F, Vann MA, et al. Society for Ambulatory Anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery. Anesthesia and analgesia. 2010;111(6):1378-1387.
  25. Kabon B, Akca O, Taguchi A, et al. Supplemental intravenous crystalloid administration does not reduce the risk of surgical wound infection. Anesthesia and analgesia. 2005;101(5):1546-1553.
  26. Kurz A. Thermal care in the perioperative period. Best practice & research Clinical anaesthesiology. 2008;22(1):39-62.
  27. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. The New England journal of medicine. 1996;334(19):1209-1215.
  28. Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Annals of surgery. 2013;257(1):8-14.
  29. Letzelter J, Hill JB, Hacquebord J. An Overview of Skin Antiseptics Used in Orthopaedic Surgery Procedures. The Journal of the American Academy of Orthopaedic Surgeons. 2018.
  30. Lippitt MH, Fairbairn MG, Matsuno R, et al. Outcomes Associated With a Five-Point Surgical Site Infection Prevention Bundle in Women Undergoing Surgery for Ovarian Cancer. Obstetrics and gynecology. 2017;130(4):756-764.
  31. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. The New England journal of medicine. 2014;370(13):1198-1208.
  32. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. American journal of infection control. 1999;27(2):97-132; quiz 133-134; discussion 196.
  33. Meijs AP, Koek MBG, Vos MC, Geerlings SE, Vogely HC, de Greeff SC. The effect of body mass index on the risk of surgical site infection. Infection control and hospital epidemiology. 2019:1-6.
  34. Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet (London, England). 2001;358(9285):876-880.
  35. Mitchell NJ, Evans DS, Kerr A. Reduction of skin bacteria in theatre air with comfortable, non-woven, disposable clothing for operating-theatre staff. British medical journal. 1978:1(6114):696-698.
  36. Moreno Elola-Olaso A, Davenport DL, Hundley JC, Daily MF, Gedaly R. Predictors of surgical site infection after liver resection: a multicentre analysis using National Surgical Quality Improvement Program data. HPB : the official journal of the International Hepato Pancreato Biliary Association. 2012;14(2):136-141.
  37. Platt R, Zaleznik DF, Hopkins CC, et al. Perioperative antibiotic prophylaxis for herniorrhaphy and breast surgery. The New England journal of medicine. 1990;322(3):153-160.
  38. Prevention CfDCa. Surgical Site Infection. Accessed July 9, 2019.
  39. Qadan M, Akca O, Mahid SS, Hornung CA, Polk HC, Jr. Perioperative supplemental oxygen therapy and surgical site infection: a meta-analysis of randomized controlled trials. Archives of surgery (Chicago, Ill : 1960). 2009;144(4):359-366; discussion 366-357.
  40. Quain AM, Khardori NM. Nutrition in Wound Care Management: A Comprehensive Overview. Wounds : a compendium of clinical research and practice. 2015;27(12):327-335.
  41. Scaltriti S, Cencetti S, Rovesti S, Marchesi I, Bargellini A, Borella P. Risk factors for particulate and microbial contamination of air in operating theatres. The Journal of hospital infection. 2007;66(4):320-326.
  42. Sessler DI. Mild perioperative hypothermia. The New England journal of medicine. 1997;336(24):1730-1737.
  43. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92(2):578-596.
  44. Sessler DI. Perioperative thermoregulation and heat balance. Lancet (London, England). 2016;387(10038):2655-2664.
  45. Son HJ, Roh JL, Choi SH, Nam SY, Kim SY. Nutritional and hematologic markers as predictors of risk of surgical site infection in patients with head and neck cancer undergoing major oncologic surgery. Head & neck. 2018;40(3):596-604.
  46. Sorensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Annals of surgery. 2012;255(6):1069-1079.
  47. Steinberg JP, Braun BI, Hellinger WC, et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors. Annals of surgery. 2009;250(1):10-16.
  48. Steiner HL, Strand EA. Surgical-site infection in gynecologic surgery: pathophysiology and prevention. American journal of obstetrics and gynecology. 2017;217(2):121-128.
  49. Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database of Systematic Reviews. 2011(11).
  50. Tanner J, Padley W, Assadian O, Leaper D, Kiernan M, Edmiston C. Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients. Surgery. 2015;158(1):66-77.
  51. Teter J, Guajardo I, Al-Rammah T, Rosson G, Perl TM, Manahan M. Assessment of operating room airflow using air particle counts and direct observation of door openings. American journal of infection control. 2017;45(5):477-482.
  52. Tewksbury C, Crowley N, Parrott JM, et al. Weight Loss Prior to Bariatric Surgery and 30-Day Mortality, Readmission, Reoperation, and Intervention: an MBSAQIP Analysis of 349,016 Cases. Obesity surgery. 2019.
  53. Thorgersen EB, Goscinski MA, Spasojevic M, et al. Deep Pelvic Surgical Site Infection After Radiotherapy and Surgery for Locally Advanced Rectal Cancer. Annals of surgical oncology. 2017;24(3):721-728.
  54. Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. The Journal of clinical endocrinology and metabolism. 2012;97(1):16-38.
  55. Varadhan KK, Lobo DN. A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right. The Proceedings of the Nutrition Society. 2010;69(4):488-498.
  56. Weigelt JA, Lipsky BA, Tabak YP, Derby KG, Kim M, Gupta V. Surgical site infections: Causative pathogens and associated outcomes. American journal of infection control. 2010;38(2):112-120.
  57. Winfield RD, Reese S, Bochicchio K, Mazuski JE, Bochicchio GV. Obesity and the Risk for Surgical Site Infection in Abdominal Surgery. The American surgeon. 2016;82(4):331-336.
  58. Yoshii T, Hirai T, Yamada T, et al. A Prospective Comparative Study in Skin Antiseptic Solutions for Posterior Spine Surgeries: Chlorhexidine-Gluconate Ethanol Versus Povidone-Iodine. Clinical spine surgery. 2018;31(7):E353-e356.
  59. Yuwen P, Chen W, Lv H, et al. Albumin and surgical site infection risk in orthopaedics: a meta-analysis. BMC surgery. 2017;17(1):7.

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