“A surgical site infection (SSI) is defined as an infection of the incision (superficial SSI), the
tissue below the incision (deep SSI), or within the abdominal cavity (organ space SSI). SSI
accounts for more than 20% of all health care-associated infections and is the most common
infection after surgery, affecting an estimated 300,000 patients annually. Compared with
other surgical subspecialties, patients undergoing colorectal surgery are at the highest risk
for developing an SSI with an estimated incidence of 5% to 30%. Patients undergoing
emergency colorectal surgery with colon perforation have an SSI incidence as high as 80%.”

TABLE 2.

Summary and strength of GRADE recommendations for preventing SSIs

Summary		Recommendation strength	GRADE quality of evidence
1	Implementing an SSI bundle for patients undergoing colorectal surgery can decrease the incidence of SSI	Strong	Moderate
2	Oral antibiotics in combination with mechanical bowel preparation have been shown to decrease the incidence of SSI after elective colorectal resection	Strong	Moderate
3	In circumstances where a mechanical bowel preparation is contraindicated or otherwise omitted, preoperative oral antibiotic preparation alone can reduce the incidence of SSI	Conditional	Moderate
4	Showering with chlorhexidine before colorectal surgery does not significantly impact SSI rates	Strong	Moderate
5	Smoking cessation before surgery may be recommended to reduce the risk of SSI	Conditional	Moderate
6	On the day of colorectal surgery, patients should have their hair removed from the surgical site using a clipper or not removed at all. Shaving with a razor before surgery is discouraged	Strong	Moderate
7	Patients undergoing colorectal resection should have parenteral antibiotics administered within 60 min of incision. Dosing and redosing should be based on the pharmacokinetic profile of the antibiotic	Strong	Low
8	Patients who report a penicillin allergy may be evaluated for having true hypersensitivity and high-risk reactions to penicillin. Delabeling a penicillin-allergic patient can facilitate the appropriate use of a preoperative prophylactic beta-lactam antibiotic and improve outcomes	Conditional	Low
9	For most clean and clean-contaminated cases, prophylactic parenteral antibiotics should be limited to the initial 24 h postoperatively	Strong	Moderate
10	Cleansing the surgical site with chlorhexidine–alcohol-based preparation is typically recommended for patients undergoing colorectal surgery	Strong	Moderate
11	Hyperglycemia on the day of surgery and in the immediate postoperative period may increase the risk of SSI after elective colorectal resection	Conditional	Moderate
12	Maintaining intraoperative normothermia may decrease the incidence of SSI in patients undergoing colorectal surgery	Conditional	Low
13	High-fractionated oxygen is not routinely recommended to prevent SSI	Conditional	Moderate
14	Wound protectors can decrease the incidence of SSI after colorectal surgery	Strong	High
15	Minimally invasive colorectal surgery can decrease the incidence of SSI compared to open surgery	Strong	High
16	Topical antimicrobial agents applied to the surgical incision are not recommended	Strong	Low
17	NPWT for primarily closed incisions may decrease the incidence of SSI	Conditional	Moderate
18	Advanced silver or antimicrobial dressings are not routinely recommended for clean or clean-contaminated wounds after colorectal surgery	Conditional	Moderate

GRADE = Grading of Recommendations, Assessments, Development, and Evaluation; NPWT = Negative pressure wound therapy; SSI = surgical site infection.

“The final grade of recommendation and level of evidence for each statement were
determined using the Grades of Recommendation, Assessment, Development, and
Evaluation (GRADE) system. The certainty of evidence reflects the extent of our confidence
in the estimates of effect. Evidence from randomized controlled trials (RCTs) starts with
high certainty, and evidence derived from observational studies starts with low certainty.
The evidence is graded for each outcome as high, moderate, low, or very low (Table 1).
The evidence can be rated for risk of bias, inconsistency, indirectness, imprecision, and
publication bias. The certainty of evidence originating from observational studies can be
rated up when there is a large magnitude of effect or dose–response relationship. As per
GRADE methodology, recommendations are labeled as “strong” or “conditional.” Current
recommendations are stated in Table 2. When agreement regarding the evidence base
or treatment guidelines was incomplete, consensus from the committee chair, vice chair,
and 2 assigned reviewers determined the outcome. Recommendations formulated by the
subcommittee were reviewed by the entire CPG Committee.”

Shogan, Benjamin D et al. “The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Preventing Surgical Site Infection.” Diseases of the colon and rectum vol. 67,11 (2024): 1368-1382. Free Full Text