Abstract: Perioperative infection is a critical complication affecting surgical prognosis, with surgical site infection (SSI) being the most common. This paper systematically reviews the mechanisms of action for the four major microecological systems in perioperative infection and new strategies for prevention and control, including skin microbiota intervention, nasal decolonization, oral care, probiotics/synbiotics application, fecal microbiota transplantation, phage therapy and other emerging technologies. Innovatively, it proposes shifting the focus of perioperative infection prevention and control from traditional "exogenous barrier" strategies to a new model emphasizing both "endogenous microecological regulation" and "exogenous prevention and control". By integrating multi-omics technologies, AI-based risk assessment and personalized interventions, it is expected to establish a precision prevention and control system, offering new insights for reducing perioperative infection.