Surgical site infections affect anywhere from 1% to 30% of patients depending on the procedure, making them one of the most common complications after surgery. In the United States alone, roughly 157,500 cases were reported in 2018, and about 8,205 of those were fatal. The good news: many of these infections are preventable, and steps you take before, during, and after your operation can meaningfully lower your risk.
Why Surgical Site Infections Happen
Bacteria are the root cause. They can come from your own skin, from the surgical environment, or from deeper tissues exposed during the procedure. Your body’s immune system normally handles small bacterial exposures, but surgery creates a perfect storm: a break in the skin barrier, tissue trauma, and sometimes reduced blood flow to the wound. Certain surgeries carry higher baseline risk. Clean orthopedic procedures in controlled settings may have infection rates below 1%, while complex trauma surgeries involving open fractures can see rates above 50%.
Several personal factors also raise the odds. Diabetes, obesity, smoking, malnutrition, and a weakened immune system all make it harder for your body to fight off bacteria at the incision site. That’s why preparation in the weeks before surgery matters just as much as what happens in the operating room.
Quit Smoking at Least Four Weeks Before
Smoking constricts blood vessels and reduces the oxygen supply your tissues need to heal and resist infection. Multiple systematic reviews recommend stopping at least four weeks before surgery to see a real reduction in complications, including surgical site infections. In one study of patients undergoing cancer surgery, those who quit less than four weeks before their operation had nearly nine times the risk of a serious wound complication compared to nonsmokers. But patients who quit more than four weeks out had complication rates similar to people who had never smoked at all.
The same pattern holds across different types of surgery. Women undergoing breast reconstruction who stopped smoking at least four weeks beforehand experienced complication rates comparable to nonsmokers. If your surgery date is more than a month away, that window is an opportunity. Even if it’s closer, quitting still helps with general recovery.
Skin Preparation Before Surgery
The antiseptic used to clean your skin before the incision plays a surprisingly large role. Chlorhexidine-based solutions kill bacteria faster and keep working longer on the skin than the traditional iodine-based alternatives. A meta-analysis of existing studies found that chlorhexidine is more effective at preventing surgical site infections overall, thanks to its ability to rapidly eliminate surface bacteria and reduce bacterial migration into the wound. Most surgical teams now use chlorhexidine-alcohol solutions as the default prep.
You may also be asked to shower or bathe with a chlorhexidine wash the night before and the morning of surgery. Follow those instructions carefully, paying attention to the area around the planned incision.
Skip the Razor for Hair Removal
If hair needs to be removed from the surgical site, how it’s removed matters. Shaving with a razor creates tiny nicks and cuts in the skin that become entry points for bacteria. A Cochrane review found that using electric clippers instead of a razor reduced the risk of skin injury by about 74%. Depilatory creams performed even better on that front, with razor users experiencing roughly seven times more skin injuries than cream users.
The timing also matters. Removing hair on the day of surgery, rather than the night before, appears to slightly reduce infection risk. If your surgical team hasn’t mentioned hair removal, don’t shave the area yourself. Let them handle it with the right tools at the right time.
Antibiotic Timing Is Critical
Preventive antibiotics are standard for many surgeries, but the clock matters. The goal is to have the antibiotic circulating in your bloodstream at effective levels right when the incision is made. A study of more than 32,000 operations found that the ideal window is within 60 minutes before the first cut. When antibiotics were given more than 60 minutes before incision, infection rates rose by about 34%.
This is largely out of your hands, but it’s worth knowing because delays in the surgical schedule or in getting an IV started can push the timing off. If you’re aware of the importance, you can ask your care team whether your prophylactic antibiotic has been given before you’re wheeled into the operating room.
Keeping Your Body Temperature Stable
Your core body temperature can drop during surgery, especially during long procedures. Even mild hypothermia, a drop of just one or two degrees, impairs the immune cells that fight bacteria at the wound site. Current guidelines recommend maintaining body temperature above 35.5 to 36°C (about 96 to 97°F) throughout the procedure.
Surgical teams use warming blankets, heated IV fluids, and temperature monitoring to prevent this. If you tend to get cold easily, mention it. And if you’re shivering in the pre-op area, ask for a warm blanket. Staying warm isn’t just about comfort; it’s a measurable factor in infection prevention.
Blood Sugar Control Before and After
High blood sugar weakens white blood cells and slows wound healing, which is why glucose management is a key part of infection prevention. This applies to everyone, not just people with diabetes. The stress of surgery itself can spike blood sugar levels temporarily.
A meta-analysis in the British Journal of Surgery found that keeping blood glucose below 150 mg/dL during and after surgery significantly reduced surgical site infections. Tighter control does carry a small risk of blood sugar dropping too low, but the study found no significant increase in serious side effects. If you have diabetes, work with your doctor in the weeks before surgery to optimize your control. If you don’t have diabetes but are prediabetic or have been eating poorly, the same principle applies: getting your blood sugar in a healthy range before the operation gives your body the best chance at fighting off infection.
Caring for Your Incision Afterward
The initial surgical dressing is customarily left in place for at least 48 hours. During this period, the wound is forming its earliest protective seal. Research from Cochrane suggests that removing the dressing earlier, within 24 to 48 hours, doesn’t appear to increase infection risk for clean or clean-contaminated wounds. But that decision should be guided by your surgical team’s instructions, not by your own impatience or discomfort.
Once the dressing comes off, the basics matter most. Wash your hands before touching the area. Keep the incision clean and dry. Watch for the warning signs of infection: increasing redness that spreads beyond the wound edges, warmth, swelling, drainage that’s cloudy or foul-smelling, or a fever above 101°F (38.3°C). Catching an infection in its first day or two, before it sets in deeper, makes treatment far simpler.
What You Can Control vs. What Your Team Handles
Some of the most effective infection prevention strategies happen in the operating room and are managed entirely by your surgical team: sterile technique, proper ventilation, antibiotic timing, temperature management, and minimizing how long tissue is exposed. You can’t control those directly, but you can choose a surgical team and facility with strong infection prevention protocols. Hospitals publicly report their infection rates for common procedures, and it’s reasonable to ask about them.
What you can directly control is your preparation. Quitting smoking at least four weeks ahead, managing blood sugar, following pre-surgical bathing instructions, eating well to support your immune system, and not shaving the surgical area yourself. After surgery, your job shifts to wound monitoring and keeping the incision site clean. These steps won’t eliminate risk entirely, but they meaningfully tilt the odds in your favor.