• Preoperative antimicrobial agents should only be administered according to clinical practice guidelines and coordinated so that the serum bactericidal concentration is adequate with the first incision.
• After the incision is closed, additional prophylactic antimicrobial agents are not recommended, even in the presence of a drain.
• Administer appropriate antimicrobial agents before skin incision in all cesarean procedures.
• No recommendations were made regarding additional doses of antimicrobial agents intraoperatively or concerning weight-based dosing of antimicrobial agents specifically as prophylaxis for SSI.

• It is not recommended to Application of antimicrobial agents, such as ointments, solutions, or powder to the incision site.
• Application of autologous platelet-rich plasma is not needed to prevent SSI.
• Triclosan-coated sutures may be considered.
• No recommendations were made regarding intraoperative antimicrobial irrigation or antimicrobial solutions for soaking prosthetics as prophylaxis for SSI.

• Perioperatively, all patients—including diabetics—should have blood glucose levels below 200 mg/dL.
• No recommendations have been made for optimal A1C levels or for tighter control of blood glucose levels below 200 mg/dL.

• Maintain normal temperature perioperatively. No recommendations have been made for ways to obtain/maintain normothermia, the lower limit of normal temperature, or the optimal timing or duration of normothermia.

• For patients who have normal pulmonary function, increased FiO₂ should be provided to those intubated for general anesthesia while in surgery and immediately post-extubation after surgery.
  • Optimal tissue oxygenation can be attained when normothermia and normovolemia are achieved.

• The night before surgery, patients should bathe or shower with an antiseptic agent or antimicrobial soap over their entire body.
• No recommendation is made for the number of agents to use, for the use of chlorhexidine gluconate washcloths, or the best time for the shower or bath.
• Unless contraindicated, an alcohol-based antiseptic agent should be used for intraoperative skin preparation.
• There is no need for a microbial sealant after the intraoperative skin preparation, nor for the use of antimicrobial plastic adhesive drapes for SSI prophylaxis.
• Aqueous iodophor solution is not needed for lavage in contaminated or dirty abdominal procedures, but it may be considered for irrigation of deep tissue or subcutaneous tissue lavage.
• Before implanting a prosthetic device, there is no recommendation for soaking the device in antiseptic solution.
• No recommendation is made for the reapplication of the antiseptic agent before closing the surgical incision.

• Blood transfusions should be given when needed; there is no reason to withhold a transfusion for prevention of SSI.

• There is no need for additional antimicrobial prophylaxis doses after the incision is closed even if the patient is receiving systemic corticosteroids or immunosuppressive medications.

• Preoperative intra-articular corticosteroid injection
• Anticoagulation
• Orthopedic space suits
• Prevention of biofilm formation

Berríos-Torres, S. I., Umscheid, C. A., Bratzler, D. W., Leas, B., Stone, E. C., Kelz, R. R., Reinke, C. E., Morgan, S., Solomkin, J. S., Mazuski, J. E., Dellinger, E. P., Itani, K. M. F., Berbari, E. F., Segreti, J., Parvizi, J., Blanchard, J., Allen, G., Kluytmans, J. A. J. W., Donlan, R., Schecter, W. P., … Healthcare Infection Control Practices Advisory Committee (2017). Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA surgery, 152(8), 784–791. https://doi.org/10.1001/jamasurg.2017.0904  Accessed December 2018 via the Web at https://jamanetwork.com/journals/jamasurgery/fullarticle/2623725