Developing a standardised surgical site infection prevention bundle: a scoping review of clinical practice guidelines

Surgical site infections (SSIs) are common and preventable, yet many perioperative recommendations in clinical practice guidelines (CPGs) are embedded within broader perioperative pathways and inconsistently framed as SSI-preventive. We synthesised guideline-based perioperative interventions, evaluated recommendation strength and supporting evidence, assessed explicit SSI framing, and developed a tiered SSI-focused implementation framework.

This scoping review analysed English-language CPGs published January 1, 2012-July 1, 2025, identified via PubMed, EMBASE, guideline repositories, and professional organisation websites. Intervention statements were extracted without SSI-specific prefiltering, aggregated via prespecified operational rules, mapped to SSI-related domains, and assessed for explicit SSI framing, recommendation strength, evidence level, and methodological rigour (using pragmatic AGREE II appraisal). Interventions were classified as universal core, expanded clinical, or system-level/contextual measures.

Forty-four CPGs yielded 40 aggregated perioperative intervention domains. Explicit SSI framing varied substantially. Intraoperative infection-control and wound-related measures showed the most consistent SSI linkage, strongest recommendations, and moderate-to-high certainty evidence. Physiological, behavioural, nutritional, and organisational measures were frequently recommended but less consistently framed as SSI-preventive and more context-dependent. Enhanced recovery after surgery (ERAS) guidelines contained substantial implicit SSI-relevant content. The final framework comprised nine universal measures (six high-priority essentials and three additional universal measures), a broader set of expanded clinical SSI-relevant measures, and a system-level contextual enabling measures.

Perioperative guidance contains substantial SSI-relevant content, but explicit SSI framing is inconsistent. This review provides a structured descriptive synthesis of current guideline recommendations and a tiered SSI-focused framework that may support local audit, implementation design, and future prospective evaluation, but does not constitute a validated universal standard.