Preventing surgical site infection (SSI) has always been a difficult task. For example, the development of infection in incisional wounds is the most common complication in open and laparoscopic surgery. This short paper provides an overview of developments in the prevention of postoperative wound infections and explains why surgeons should place greater emphasis on the standardisation and documentation of wound care.

INTRODUCTION
Despite the many recent advances in modern surgery, poor wound healing and the development of infections in incisional wounds continue to be the most common complications in open and laparoscopic surgery.

According to the literature, the incidence of infected wounds after midline laparotomy varies from 4-19%[1,2]. These complications are associated with significant secondary morbidity and even mortality, especially in high-risk patient cohorts[3,4]. Furthermore, infected wounds are associated with high costs due to prolonged hospitalisation, extended wound care and the loss of patient earnings[3,5]. Although these factors are well known among clinicians, there has been little improvement in surgical site infection (SSI) rates in recent decades. 

At least part of the problem is administrative. The lack of standardised wound care documentation across different healthcare settings and countries means that the number of infected wounds is still underestimated in many centres. In recent years research has focused more on high infection rates, however strategies to prevent wound infection are now rising up the healthcare agenda.


STANDARDISING TREATMENT AND DOCUMENTATION
Various risk factors for the development of poorly healing wounds have been identified[1-3,6] such as impaired microcirculation and immunosuppression. While patient-related factors, such as age, sex, body mass index (BMI), underlying disease, co-morbidities, previous surgery and lifestyle factors (ie smoking) are difficult to control, procedures related to surgery are much easier for clinicians to standardise. Factors controllable by clinicians include:

• The quality and consistency of surgical technique
• Skin antisepsis
• Appropriate antimicrobial prophylaxis
• Identification of strategies for decreasing wound contamination[6]
• Standardised wound documentation to accurately record specific infection rates.

PREVENTING WOUND INFECTIONS
As almost all postoperative wound infections develop along suture lines or in the immediate vicinity, the role of suture material in the development of wound infections has been the subject of speculation among surgeons since the 1960s[7,8]. Bacteria not only contaminate the tissue in the surgical wound, but also the suture material itself[9,10], which can play an important role as a nidus for wound infections.
 
To prevent contamination, suture materials have been developed that have been coated in triclosan, which has antiseptic properties. An analysis by the authors of more than 2,000 patients demonstrated that the use of antiseptic-coated sutures (Vicryl® Plus, Ethicon) reduced the number of wound infections after midline abdominal wall incision[11].
 
While these results are not yet supported by large clinical studies, they do suggest that the use of antiseptic sutures, together with persistent skin antisepsis, meticulous operative techniques and appropriate antimicrobial prophylaxis, may help to prevent wound infections.
 
After stapling the wound, it is covered with a sterile adhesive dressing for two days. When this is removed the wound is cleaned with antiseptic then covered with a new sterile dressing. The dressing is changed daily until the staples are removed on day 12 postoperatively.