Most surgical site infections are preventable, and the steps you take before, during, and after your procedure all matter. Globally, health organizations have identified 29 specific recommendations spanning the entire surgical timeline, but the actions with the biggest payoff are surprisingly simple: clean skin, controlled blood sugar, good nutrition, and proper wound care at home. Here’s what actually makes a difference.
Before Surgery: What You Can Do Ahead of Time
The weeks leading up to surgery are your best window to lower infection risk. Two changes stand out above the rest: quitting smoking and getting blood sugar under control.
If you smoke, stopping 4 to 6 weeks before your operation and staying smoke-free for 4 weeks afterward cuts your rate of wound complications by 50%, according to the American College of Surgeons. Smoking constricts blood vessels and starves healing tissue of oxygen, so even a few weeks without cigarettes gives your body a measurable advantage.
For people with diabetes, blood sugar control matters more than many realize. Research shows that a long-term blood sugar marker (A1c) at 8% or above is associated with a 2.7 times greater risk of surgical infection. Once A1c climbs above 10%, the absolute risk of complications rises significantly. If your surgery is elective, talk to your care team about optimizing your blood sugar in the months beforehand. Even during a hospital stay, keeping average blood glucose below 180 mg/dL reduces the need for additional procedures to drain infections.
The Pre-Surgery Shower
Your surgical team will likely give you a special antiseptic soap, typically chlorhexidine, and ask you to shower with it twice: once the evening before surgery and once the morning of. The technique matters more than you might think. Turn off the water before lathering the soap onto your skin, let it sit for a full minute, then rinse thoroughly. This contact time is what allows the antiseptic to reduce bacteria on your skin. Avoid applying lotions, powders, or deodorant afterward, as these can interfere with the soap’s protective effect.
Nutrition That Supports Healing
Your body rebuilds tissue using protein, and surgical wounds increase your protein needs substantially. Current recommendations call for 1.2 to 1.5 grams of protein per kilogram of body weight each day during wound healing. For a 150-pound person, that works out to roughly 80 to 100 grams of protein daily, which is significantly more than most people eat in a normal day. Good sources include eggs, chicken, fish, Greek yogurt, beans, and protein supplements if whole foods aren’t enough.
Starting to build up your protein intake a week or two before surgery gives your body a head start. Adequate vitamin C and zinc also support tissue repair, but protein is the single most important dietary factor for wound healing.
Caring for Your Wound at Home
Once you’re home, how you handle the surgical dressing has a direct effect on infection risk. The initial dressing placed in the operating room should stay on for at least 48 hours. This is the critical window when the surface layer of skin begins to seal over the incision, creating a natural barrier against bacteria.
Timing your first dressing change matters. A network meta-analysis comparing different dressing change schedules found that changing the dressing at 48 hours produced the lowest infection rates. Leaving a dressing on for more than 4.5 days tripled the risk of wound infection compared to changing it at 48 hours. So while it’s tempting to leave the bandage alone, a timely change is actually safer than a delayed one.
When you do change the dressing, wash your hands thoroughly first. Use clean (not necessarily sterile) supplies unless your surgeon specifies otherwise. Look at the wound each time you change the dressing, since catching early signs of infection depends on knowing what normal healing looks like.
When Can You Shower?
This is one of the most common questions after surgery, and surprisingly, there’s no universal rule. Traditional advice has been to keep the wound dry for at least 48 hours, since that’s how long the skin surface takes to reseal. A large trial randomized over 850 patients to either resume normal bathing within 12 hours or wait at least 48 hours, and found no firm evidence that either approach was clearly better. Your surgeon’s specific instructions should take priority, but in general, brief showers are typically allowed after the first 48 hours. Avoid soaking in bathtubs, pools, or hot tubs until the incision is fully closed, as standing water carries a higher contamination risk than running water.
Signs of Infection to Watch For
Knowing what’s normal and what’s not can save you from a minor infection becoming a serious one. Some redness and tenderness right around the incision is expected in the first few days. What’s not normal is redness that spreads outward from the wound, increasing pain rather than decreasing pain, or any of these warning signs:
- Pus or cloudy drainage from the incision
- A bad smell coming from the wound
- Fever or chills, particularly a temperature above 100.4°F (38°C)
- Skin that feels hot around the incision
- Worsening redness or swelling that expands over hours or days
Superficial infections involve only the skin and tissue just beneath it, producing redness, swelling, and sometimes pus. Deeper infections can cause fever, intense localized pain, and sometimes the wound edges will begin to separate. If you notice any of these signs, contact your surgeon’s office rather than waiting for your next scheduled follow-up.
The Financial Cost of Infection
Beyond the health consequences, surgical infections carry a steep financial toll. Research published in The Joint Commission Journal on Quality and Patient Safety found that infections add between $40,600 and $68,100 in medical costs per person over the following year, depending on the type of surgery. Out-of-pocket costs for patients ranged from $330 to $860 on top of that. Prevention is far cheaper than treatment, which often involves additional procedures, extended antibiotics, and longer recovery times.
A Practical Checklist
Pulling it all together, these are the highest-impact steps in your control:
- 4 to 6 weeks before surgery: Stop smoking. Get blood sugar checked and optimized if you have diabetes.
- 1 to 2 weeks before: Increase your daily protein intake toward 1.2 to 1.5 grams per kilogram of body weight.
- The night before and morning of: Shower with the antiseptic soap provided, letting it sit on your skin for one minute before rinsing.
- First 48 hours after: Leave the surgical dressing in place. Avoid getting the wound wet unless told otherwise.
- At 48 hours: Change the dressing with clean hands and clean supplies. Inspect the wound.
- Ongoing: Keep eating high-protein meals, watch for warning signs at every dressing change, and stay smoke-free for at least 4 weeks after surgery.