Towards better surgical site infection prevention

Surgical site infections (SSI) remain a common postoperative complication that is costly and burdensome for patients. This thesis aims to optimize the prevention of SSI through two key strategies: rational use of surgical antibiotic prophylaxis (SAP) and the integration of evidence-based perioperative interventions into care bundles.
Part I demonstrates that timely administration, intraoperative redosing when indicated, and immediate discontinuation of SAP effectively reduce SSI risk while supporting antimicrobial stewardship. Additionally, a systematic review found that intraoperative incisional irrigation with povidone–iodine significantly reduced SSI, whereas antibiotic irrigation did not.
Part II evaluates the added value of care bundles for the prevention of SSI. A systematic review showed that implementation of bundles led to a reduction in SSI rates, particularly when composed of evidence-based elements.
Based on these findings, the EPO₂CH trial was developed and conducted—a pragmatic, multicentre RCT testing a five-component care bundle (high FiO₂, goal-directed fluid therapy, active warming, glucose control, and antiseptic irrigation).