Objectives: Multicenter surveillance regarding the knowledge, attitude and application of precautionary measures and resulting improvement in the surgical site infection (SSI) rate in hospitals of Ministry of Health (MOH) in Saudi Arabia. Design: Prospective cohort study, from Moharram to Zil Hajj 1434 H. (15/11/2012 to 5/11/ 2013). Setting: MOH hospitals in four areas of Makkah region, Saudi Arabia. Study participants and interventions. The surgical healthcare staff in the specified hospitals was subjected to a questionnaire encompassing the important parameters including faculty expertise and hospital policies regarding prevention of SSI. Representative data from 09 hospitals was subjected to regular evaluation for the incidence of SSI. Results: More than 80% hospitals showed keen interest in preventive measures against SSI and 60-100% (mean 80%) hospitals observed the required practices against nosocomial infections. Average SSI rate remained in the range of 0.39 to 2.12 with the mean value of 0.95. A decreasing incidence of SSI was observed over the time period of study. Conclusion: Surveillance and participation of all the participants reduced the incidence of SSI during one year period. Our results suggest that continuous surveillance can bring excellent results but this trend need lot of effort for its continuation.