Decolonisation and approaches to this for preventing surgical site infection

Surgical site infections (SSIs) are a major cause of postoperative morbidity, financial burden and antimicrobial resistance. Despite evidence-based prevention bundles, adherence varies significantly, with rates of SSIs differing by up to 25-fold between institutions. Decolonisation, particularly nasal decolonisation targeting Staphylococcus aureus, is a critical but underused component of SSI prevention. Options for decolonisation include universal or targeted strategies. National and international guidelines recommend mupirocin as the gold standard, but there are complexities in the screening and administration of the antibiotic as well as potential issues with compliance, time needed to treat and antimicrobial resistance. Alternatives to the use of mupirocin include chlorhexidine, octenidine, povidone-iodine, and a nasal photodisinfection technology. These alternatives may provide practical solutions to some of the challenges associated with antibiotic use but further evidence is required to evaluate their efficacy. Enhanced adherence to decolonisation protocols, supported by robust evidence and aligned with antimicrobial stewardship, offers a clear opportunity to reduce SSIs, improve patient outcomes and support sustainable surgical care. This article explores the current evidence, clinical guidelines and antimicrobial stewardship considerations related to decolonisation strategies.