Surgical site infection prevention: a scoping review of strategies, implementation barriers, and emerging approaches.

BACKGROUND: Surgical site infections (SSIs) remain a major cause of healthcare-associated morbidity, mortality, and increased healthcare costs worldwide, particularly in low- and middle-income countries (LMICs). Although evidence-based prevention guidelines are widely available, inconsistent implementation and variability in adherence continue to limit their effectiveness across healthcare settings. METHODS: This scoping review synthesized recent evidence on SSI prevention strategies published between 2019 and 2025. A systematic search of Scopus, Web of Science, and ScienceDirect identified 24 eligible studies. Data were extracted and thematically analyzed to examine intervention effectiveness, implementation challenges, and emerging innovations in SSI prevention. RESULTS: Core clinical strategies-including antibiotic prophylaxis, topical antisepsis and decolonization, and negative pressure wound therapy (NPWT)-were consistently effective; however, their success depended heavily on implementation fidelity. Multicomponent strategies, particularly prevention bundles, significantly improved outcomes by enhancing consistency and reducing variability in care delivery. Persistent barriers, including limited resources, inadequate training, and workflow constraints, remained major obstacles across both high- and low-resource settings. In LMICs, context-specific and low-cost interventions, such as glove and instrument changes before wound closure, demonstrated substantial effectiveness and scalability. Emerging data-driven approaches, including artificial intelligence and machine learning, showed strong potential in improving SSI risk prediction and surveillance, although infrastructural limitations continue to restrict broader implementation. CONCLUSION: SSI prevention is fundamentally an implementation-driven challenge requiring alignment between evidence-based interventions, system-level capacity, and context-sensitive adaptation. By integrating clinical, implementation, and technological perspectives, this review provides a unified framework to guide future research, policy development, and healthcare practice aimed at reducing the global burden of SSIs.