As more patients seek care in the outpatient setting, the opportunities for health care–acquired infections and associated outbreaks will increase. Without uptake of core infection prevention and control strategies through formal initiation of infection prevention programs, outbreaks and patient safety issues will surface. This review provides a step-wise approach for implementing an outpatient infection control program, highlighting some of the common pitfalls and high-priority areas.

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univariate analysis were body mass index (BMI) ≥ 35 (odds ratio, 11.11; 95% CI, 2.35-52.59; P = .002), and number of spinal levels fused >5 (odds ratio, 18; 95% CI, 2.47-131.27; P = .033).We observed a similar rate of SSI to that observed by Gu et al 1 (3.3% vs 4.4%). Our study was performed in a tertiary care university hospital, where patients usually have more serious pathologies and are therefore more at risk of SSI, and we included patients with history of spinal surgery (which is a risk factor for SSI). Gu et al 1 included patients from level 1 and level 2 hospitals.The univariate analysis allowed us to identify BMI ≥ 35 and the number of spinal levels fused higher than 5, which were not identified as risk factors by Gu et al. 1 This difference could be explained by analytical differences. Indeed, for BMI, we treated the variable as a binary categorical variable (BMI ≥ 35 or <35), whereas Gu et al 1 used 5 BMI categories. Our categories for the reason for surgery (herniated disc, trauma, deformation or degeneration) were different from those used by Gu et al 1 (spinal fracture only, spinal cord injury only, fracture combined with spinal cord injury, degenerative disease). Of note, reservations about Gu et al's 1 results were presented in a letter to the editor by Garcia et al, 2 who questioned the validity of their model and therefore their results and their interpretation. We did not perform a multivariate analysis given the small number of cases and the limitations of such an analysis highlighted by Garcia et al. 2 Our results (BMI ≥ 35 and spinal levels fused), based on prospective surveillance, highlight the specificities of obese patients during their hospital care. In a time of rising prevalence of obesity, this risk factor for SSI should be taken into account during a patient's management for spine surgery. Accordingly, following this preliminary study, we have undertaken an evaluation study to explore whether specific measures regarding cutaneous skin preparation before surgery could be implemented in a specific population of obese patients.