Modern Surgical Site Infection Prevention: Evidence, Gaps, and Future Directions.

Surgical site infections (SSIs) remain among the most consequential and costly complications in surgery. Their persistence reflects the expanding threat of multidrug-resistant (MDR) organisms and the practical limits of even increasingly data-driven, systems-level prevention programs. Contemporary prevention is multimodal across the perioperative pathway. Preoperatively, patient optimization is central, and foundational measures include alcohol-based skin antisepsis, nutritional support, smoking cessation, and strict glycemic control. Intraoperatively, the emphasis shifts to technical precision and physiologic stability, including gentle tissue handling, maintenance of normothermia, appropriate oxygenation, and disciplined operating-room traffic. In parallel, material science and precision medicine are reshaping the armamentarium: antimicrobial sutures and surface coatings, host-directed immunomodulation, and personalized, risk-adapted strategies offer targeted protection. This narrative review synthesizes current evidence across these domains. We aim to clarify which measures carry the strongest support, identify persistent gaps and implementation challenges, and outline priorities for future research and practice.