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Background: The high prevalence of surgical site infection (SSI) in colon surgery, and the clinical and economic impacts of such infections, make its monitoring and prevention a priority., Methods: We conducted a prospective cohort study to estimate the rate of SSI in colon surgery and the degree of compliance with antibiotic prophylaxis and pre-operative preparation protocols. The study population comprised patients who underwent colon surgery at the University Hospital of the Alcorcon Foundation in Alcorcon, Spain, from October 2007 to December 2009. Risk factors, the observance of antibiotic prophylaxis, and compliance with pre-operative preparation protocols were monitored; and their influence on SSIs was followed for 30 days after surgery. The main outcome measure was comparisons of the rates of SSI in patients undergoing colon surgery in Madrid and across the whole of Spain and in the United States, as determined in accordance with the surveillance parameters of the National Nosocomial Infections Surveillance (NNIS) index., Results: Among a total of 132 patients, we found a 10.6% rate of SSI. The indirect standardization rate at our hospital was 1.75-fold for the United States and 0.64-fold and 0.61-fold, respectively, the rates for Madrid and all of Spain. The rates of compliance with antibiotic prophylaxis and pre-operative preparation protocols were 93.6% and 56.8%, respectively. No relation could be established between these data and the rate of infection. The risk factors for SSI found in a multivariable analysis were the degree of contamination in surgery and the presence of chronic obstructive pulmonary disease (COPD; p<0.05)., Conclusions: The rate of SSI in our study population was below that for Madrid and Spain but higher than that for the United States. Thorough adherence to the monitoring system was essential for obtaining these results.