Nosocomial infections occur in 10% to 20% of cardiac surgery patients. To prevent surgical site infections in CABG patients, a multimodality approach involving several periop- Hillis et al 2011 ACCF/AHA CABG Guideline e689 erative interventions must be considered. Preoperative inter- ventions include screening and decolonization of patients with methicillin-resistant and methicillin-sensitive S. aureus colonization and adequate preoperative preparation of the patient. Nasal carriage of S. aureus is a well-defined risk factor for subsequent infection. In proven nasal carriers of S. aureus, intranasal mupirocin reduces the rate of nosocomial S. aureus infection, but it does not reduce the rate of surgical site infection with S. aureus.928,929 Preoperative patient bath- ing, the use of topical antiseptic skin cleansers (chlorhexidine gluconate),930 932 and proper hair removal techniques (using electric clippers or depilatories rather than razors)933 937 are important measures with which to prepare the patient for surgery. Intraoperative techniques to decrease infection include strict adherence to sterile technique, minimization of operat- ing room traffic, less use of flash sterilization of surgical instruments, minimization of electrocautery933,936 and bone wax,938 use of double-gloving,938 943 and shorter operative times. identification of patients at high risk for preoperative infection allows the clinician to maximize prevention strate- gies. Superficial wound infection occurs in 2% to 6% of patients after cardiac surgery,656,944 946 and deep sternal wound infection occurs in 0.45% to 5%, with a mortality rate The etiology of deep sternal wound infection is multifac- torial. Risk factors for deep sternal wound infection are diabetes mellitus,25,27,28 obesity (body mass index 30 kg/ ),947,949,950,953,954 chronic obstructive pulmonary disease,950 prolonged CPB time, reoperation, prolonged intubation time, and surgical reexploration.945,947,955 Potentially modifiable risk factors are smoking cessation, optimized nutritional status, adequate preoperative glycemic status (with hemoglo- bin A1c 6.9%), and weight loss. 