Surgical-site infections and routes of bacterial transfer: Which ones are most plausible?

Background Surgical-site infections (SSIs) are an unfortunate consequence of cutaneous surgery. Their incidence can be a significant problem for patients and surgeons. Most SSIs are presumed to originate from the patient and operating room staff. Objectives To review the potential routes of iatrogenic bacterial transfer during cutaneous surgery. Methods A review of the medical literature. Conclusions Potential routes of bacterial transfer during surgery include respiratory droplets and nuclei, skin scales carried on air currents, direct contact with the surgical team's skin, and contaminated fomites. The route with the most significant potential for iatrogenic bacterial transfer is direct physical contact. Strategies that minimize contact with infected fomites and with the surgical team would probably have the best chances of reducing the incidence of SSIs.