BACKGROUND Surgical site infection (SSI) continues to be a common if often times preventable infection. Considerable patient morbidity and economic cost are the consequences. METHODS Review of the pertinent English-language literature. RESULTS The National Surgical Infection Prevention (SIP) Project was an initiative sponsored jointly by the Centers for Medicare and Medicaid Services and the U.S. Centers for Disease Control and Prevention to decrease the incidence of SSI in major surgical procedures. Three performance measures were developed to improve the timing of antibiotic administration and the selection of the drug and to reduce needless postoperative administration of antibiotics. The success of SIP led to the Surgical Care Improvement Project (SCIP), which is expanding performance measures in the area of prevention of SSI, and also is undertaking preventive measures against postoperative venous thromboembolism and cardiac events. Federal legislation has required hospitals to report rates of compliance with many of these process measures. CONCLUSIONS Surgeons must use all documented strategies to prevent SSIs.