Table 1.

Overview of the preoperative, intraoperative, and postoperative interventions for surgical site infection

Intervention	Recommendation	Level of evidence
Preoperative
Nasal culture for MRSA/MSSA	- Swab at least 5 days prior to surgery [29] - Topical muciprocin and CHG shower if positive [29]	1B
Preoperative CHG shower	- Demonstrates benefit in shorter procedures [31]	2B
Antimicrobial surgical site preparation	- Chlorhexidine may be slightly favored over povidone-iodine [33]	2A
Intraoperative
Antibiotic prophylaxis	- 1 g cefazolin approximately 2 hours prior to surgery or earlier [40] - Clindamycin is an acceptable alternative [40] - Redosing may be necessary in long procedures [36]	1B
Intraoperative warming	- Intraoperative normothermia is optimal [47]	1A
Vancomycin powder	- Intrasite vancomycin powder is recommended as a safe and inexpensive option for SSI prevention [51–54]	2A
Postoperative
Wound drains	- Limited evidence for SSI prevention [64] - May be useful in SSI management [74]	2A
Negative pressure wound therapy	- Evidence for efficacy in SSI management [76] - Emerging evidence for efficacy in SSI prevention [83]	2A
Traditional wound dressings	- Silver and Aquaphor dressings both have antimicrobrial properties and may accelerate wound healing [88,90]	1B; 2A
Prevena wound management system	- Unique dressing that reduces SSI prevalence [93]	More studies needed in spine surgery

MRSA, Methicillin-resistant Staphylococcus aureus; MSSA, Methicillin-sensitive Staphylococcus aureus; CHG, chlorhexidine; SSI, surgical site infection.