Infection Control Bundle Competencies and Surgical Site Infection Outcomes; A Systematic Review

Abstract

Surgical site infections (SSIs) remain postoperative complications, and the effects of infection-control bundles depend on reliable implementation. This focused, PRISMA-informed narrative synthesis maps 41 primary empirical studies published from 2017 to 2025 across diverse surgical specialties. Three additional studies extend the previous 38-study evidence map. Findings include lower SSI rates after vascular and pediatric cardiac bundles, as well as improved adherence after team training in Tanzanian obstetric services. However, standardized protocols did not significantly change infection rates in a Swiss colorectal cohort, and a randomized Dutch abdominal-surgery trial found no additional reduction compared with standard care. National surveillance in the Netherlands and two independent craniotomy cohorts further illuminate adherence, postoperative technique and infection ascertainment. Common implementation domains include staff education, multidisciplinary coordination, antibiotic practice, hygiene, intraoperative technique, audit, patient instruction and documented compliance. Most evidence does not directly assess clinician competency. Variation in operations, case mix, surveillance and research designs prevents a defensible pooled causal effect. Clinical recommendations therefore require procedure-specific implementation, validated competency assessment and transparent evaluation of mixed outcomes.