Commentary: Controversies in NICE guidance on surgical site infection

BMJ 2008; 337 doi: (Published 28 October 2008) Cite this as: BMJ 2008;337:a2120
  1. Zygmunt H Krukowski, professor of clinical surgery1,
  2. Julie Bruce, senior research fellow2
  1. 1Ward 31, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN
  2. 2Section of Population Health, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD
  1. Correspondence to: J Bruce j.bruce{at}

    Major innovations and improvements have taken place over the past 20 years in the management of infected surgical sites, including the development of sophisticated wound dressings and specialist tissue viability nurses. However, we should not be complacent about surgical site infection as recent surveillance data for England show the rate to be as high as 10.5% after small bowel surgery,1 and a Scottish study found a rate of 5.3% for clean abdominal (hernia) surgery.2 As acknowledged in the latest guidance from the National Institute for Clinical Excellence (NICE),3 many confounding factors affect the identification of surgical site infection, not least 41 definitions and a variation in surveillance methods. However, it has been clear for almost three decades that the routine collection and dissemination of rates of surgical site infection results indirectly in a worthwhile reduction.4 The Scottish Surveillance of Healthcare Associated Infection Programme reported significant reductions in the rate surgical site …

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