To the Editor:
We appreciate the remarks by Arenal et al. The guidelines from the Centers for Disease Control and Prevention [1] and the American College of Surgeons [2] nicely outline the best evidence for prevention of surgical site infections (SSI). Improvements in SSI rates are noticeable, but we still have potential for more progress [3]. The research opportunities presented in our article [4] represent the authors' consensus through a modified Delphi process on the research priority areas to prevent SSI for all operations and not only gastrointestinal surgical procedures.
There are many more areas that can be addressed, and Arenal et al. are to be congratulated for their innovative approach to protect wounds by taking advantage of the self-retractors used in open gastrointestinal operations. We strongly encourage the authors to conduct a prospective randomized trial to raise the level of evidence and allow their intervention to become a standard guideline for gastrointestinal surgical procedures.
