Normothermia to Prevent Surgical Site Infections After Gastrointestinal Surgery: Holy Grail or False Idol? Evaluating an evidence-based bundle for preventing surgical site infection: a randomized trial. The Effect of Preoperative Subcutaneous Fat Thickness on Surgical Site Infection Risk in Patients Undergoing Colorectal Surgery: Results of a Multisite, Prospective Cohort Study. Surgical site infections following short-term radiotherapy and total mesorectal excision: results of a randomized study examining the role of gentamicin collagen implant in rectal cancer surgery Timing of Antimicrobial Prophylaxis and the Risk of Surgical Site Infections: Results From the Trial to Reduce Antimicrobial Prophylaxis Errors Standardized incidence rates of surgical site infection: a multicenter study in Thailand. Infliximab administration prior to surgery does not increase surgical site infections in patients with ulcerative colitis Elective Colon and Rectal Surgery Differ in Risk Factors for Wound Infection: Results of Prospective Surveillance The association of preoperative anemia and perioperative allogeneic blood transfusion with the risk of surgical site infection. Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital. Risk factors for surgical site infections after pediatric cardiovascular surgery Risk factors for surgical site infection in elective routine degenerative lumbar surgeries. Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery. Risk factors for and effect of a one-year surveillance program on surgical site infection at a university hospital in Turkey. Risk factors for surgical site infection after cardiac surgery in children. Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. Determinants of Surgical Site Infections Following Pancreatoduodenectomy Surgical site infections in Italian Hospitals: a prospective multicenter study Decolonisation of MRSA and its effect on surgical site infections--a study in a tertiary care institute. Oral Antibiotics Versus Topical Decolonization to Prevent Surgical Site Infection After Mohs Micrographic Surgery—a Randomized, Controlled Trial Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study
Objective : To analyze the association between perioperative normothermia ( temperature ≥36 ° C ) and  surgical site infections ( SSIs ) after gastrointestinal ( GI ) surgery . Summary of Background Data : Although active warming during colorectal surgery reduces SSIs , there is limited evidence that perioperative normothermia is associated with lower rates of SSI . Nonetheless , hospitals participating in the Surgical Care Improvement Project must report normothermia rates during major surgery . Methods : We conducted a nested , matched , case-control study ; cases consisted of GI surgery patients enrolled in our National Surgical Quality Improvement Program data base between March 2006 and March 2009 who developed SSIs . Patient/surgery risk factors for SSI were obtained from the National Surgical Quality Improvement Program data base . Perioperative temperature/antibiotic/glucose data were obtained from medical records . Cases/controls were compared using univariate/r and om effects/logistic regression models . Independent risk factors for SSIs were identified using multivariate/r and om effects/logistic regression models . Results : A total of 146 cases and 323 matched controls were identified ; 82 % of patients underwent noncolorectal surgery . Cases were more likely to have final intraoperative normothermia compared with controls ( 87.6 % vs. 77.8 % , P = 0.015 ) ; rates of immediate postoperative normothermia were similar ( 70.6 % vs. 65.3 % , respectively , P = 0.19 ) . Emergent surgery/higher wound class were associated with higher rates of intraoperative normothermia . Independent risk factors for SSI were diabetes , surgical complexity , small bowel surgery , and nonlaparoscopic surgery . There was no independent association between perioperative normothermia and SSI ( adjusted odds ratio , 1.05 ; 95 % confidence interval , 0.48–2.33 ; P = 0.90 ) . Conclusions : Pay-for-reporting measures focusing on perioperative normothermia may be of limited value in preventing SSI after GI surgery . Studies to define the benefit of active warming after noncolorectal GI surgery are warranted OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended arm vs 19 % st and ard arm ; P = .004 ) . Multivariate analysis suggested that allocation to the extended arm of the trial conferred a 2.49-fold risk ( 95 % confidence interval , 1.36 - 4.56 ; P = .003 ) independent of other factors traditionally associated with SSI . CONCLUSIONS An evidence -based intervention bundle did not reduce SSIs . The bundling of interventions , even when the constituent interventions have been individually tested , does not have a predictable effect on outcome . Formal testing of bundled approaches should occur prior to implementation Surgical site infection ( SSI ) is one of the most frequent postoperative complications among patients undergoing elective colorectal surgery .  A multisite , prospect i ve cohort study was conducted to investigate whether the thickness of subcutaneous fat ( TSF ) influences the occurrence of SSI in patients undergoing colorectal surgery . Participants included patients scheduled to receive colorectal laparotomy for colorectal cancer and who were under the care of a wound ostomy continence nurse at 17 participating general hospitals in Japan . Patients were not eligible to participate if they had undergone emergency surgery , reoperation , or laparoscopic surgery .  Demographic , wound , and surgical data and American Society of Anesthesiologists ( ASA ) scale scores were collected and assessed , along with nutritional status , TSF , body mass index , and risk factors for SSI ( ie , length of surgery and wound classification ) . The incidence of SSI and nutritional conditions was assessed weekly for 30 days after surgery . Of the 155 participants ( mean age 68.9 ± 10.8 years , 53 [ 34.2 % ] of whom were women ) , 90 ( 58.1 % ) underwent rectal surgery , and the remaining 65 underwent colon surgery .  Seventy-two ( 72 , 46.5 % ) of the 155 patients underwent colostomy surgery ; 24 ( 15.5 % ) developed a SSI . The mean onset of SSI was 7.3 ± 2.9 days after surgery and commonly observed in the stoma group when the ASA score was 3 or higher ( P = 0.02 ) . Patients who developed SSI resumed oral dietary intake later than those without SSI ( 7.4 days versus 4.6 days , P = 0.02 ) . Multivariate analysis indicated TSF > 15 mm ( P = 0.01 ) , Alb level < 3.5 g/dL at postoperative days 14 ( P = 0.03 ) and 21 ( P = 0.02 ) , and total protein level < 6.8 g/dL at postoperative day 7 ( P = 0.02 ) were statistically significantly correlated with SSI occurrence . These results suggest preoperative TSF and preoperative and postoperative serum albumin levels are independent risk factors for SSI in patients undergoing colorectal surgery , confirming current recommendations to maximize the preoperative nutritional status of patients in order to prevent major complications . The results also confirm obesity/TSF should be assessed preoperatively to ascertain the risk of SSI in patients undergoing colorectal surgery Background Despite the findings of several r and omized clinical studies , the role of gentamicin collagen implant ( GCI ) in rectal cancer surgery is unclear . Local pelvic application of GCI following preoperative radiotherapy and total mesorectal excision ( TME ) was evaluated to determine the risk of surgical site infections ( SSI ) . Methods In this single-center trial , 176 patients with rectal cancer after preoperative , short-term radiotherapy ( 5 × 5 Gy ) were r and omized either to the study group in which  GCI was used or in the control group without GCI . Prior to surgery and intraoperatively five patients were excluded from the study . The remaining 171 patients were analyzed ; 86 were in the study group and 85 in the control group . Results There were no statistically significant differences in the overall rate of early postoperative complications between the study and control group : 25.6 and 34.1 % respectively ; p = 0.245 , relative risk ( RR ) 0.750 [ 95 % confidence interval ( CI ) 0.471–1.195 ] . The reoperation rate was similar in both groups : 12.8 versus 9.4 % ; p = 0.628 ; RR 1.359 ; ( 95 % CI 0.575–3.212 ) . The total rate of SSI and organ space SSI were 22.2 and 15.8 % without differences between the study and control group . In patients without anastomotic leakage , the risk of organ space SSI was significantly reduced in patients who received GCI : 2.6 versus 13.0 % ; p = 0.018 . Conclusions Application of GCI in the pelvic cavity after short-term preoperative radiotherapy and TME may reduce the risk of organ space SSI but only in the absence of anastomotic leakage Objective : The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis ( AMP ) . Summary Background Data : National AMP guidelines should be supported by evidence from large contemporary data sets . Methods : Twenty-nine hospitals prospect ively obtained information on AMP from 4472 r and omly selected cardiac , hip/knee arthroplasty , and hysterectomy cases .  Surgical site infections ( SSIs ) were ascertained through routine surveillance , using National Nosocomial Infections Surveillance system methodology . The association between the prophylaxis timing and the occurrence of SSI was assessed using conditional logistic regression ( conditioning on hospital ) . Results : One-hundred thirteen SSI were detected in 109 patients .  SSI risk increased incrementally as the interval of time between antibiotic infusion and the incision increased ( overall association between timing and infection risk P = 0.04 ) . When antibiotics requiring long infusion times ( vancomycin and fluoroquinolones ) were excluded , the infection risk following administration of antibiotic within 30 minutes prior to incision was 1.6 % compared with 2.4 % associated with administration of antibiotic between 31 to 60 minutes prior to surgery ( OR : 1.74 ; 95 % confidence interval , 0.98–3.04 ) . The infection risk increased as the time interval between preoperative antibiotic and incision increased or if the antibiotic was first infused after incision . Intraoperative redosing ( performed in only 21 % of long operations ) appeared to reduce SSI risk in operations lasting more than 4 hours ( OR of 3.08 with no redosing ; 95 % confidence interval 0.74–12.90 ) , but only when the preoperative dose was given correctly . Conclusions : These data from a large multicenter collaborative study confirm and extend previous observations and show a consistent relationship between the timing of AMP and SSI risk with a trend toward lower risk occurring when AMP with cephalosporins and other antibiotics with short infusion times were given within 30 minutes prior to incision BACKGROUND No previous multicenter data regarding the incidence of  surgical site infection ( SSI ) are available in Thail and . The magnitude of the problem result ing from SSI at the national level could not be assessed . The purpose of this study was to estimate the incidence of SSI in 9 hospitals , together with patterns of surgical antibiotic prophylaxis , risk factors for SSI , and common causative pathogens . METHODS A prospect i ve data collection among patients undergoing surgery in 9 hospitals in Thail and was conducted . The National Nosocomial Infection Surveillance ( NNIS ) system criteria and method were used for identifying and diagnosing SSI . The SSI rates were benchmarked with the NNIS report by means of indirect st and ardization and reported in terms of st and ardized infection ratio ( SIR ) . Antibiotic prophylaxis was categorized into preoperative , intraoperative , and postoperative . Risk factors for SSI were evaluated using multiple logistic regression models . RESULTS From July 1 , 2003 , to February 29 , 2004 , the study included 8764 patients with 8854 major operations and identified 127 SSIs , yielding an SSI rate of 1.4 infections/100 operations and a corresponding SIR of 0.6 ( 95 % CI : 0.5 - 0.8 ) . Of these , 35 SSIs ( 27.6 % ) were detected postdischarge . The 3 most common operative procedures were cesarean section , appendectomy , and hysterectomy . The 3 most common pathogens isolated were Escherichia coli , Staphylococcus aureus , and Pseudomonas aeruginosa , which accounted for 15.3 % , 8.5 % , and 6.8 % of infections , respectively . The 3 most common antibiotics used for prophylaxis were ampicillin/amoxicillin , cefazolin , and gentamicin . The proportion of types of antibiotic prophylaxis administered were 51.6 % preoperative , 24.3 % intraoperative , and 24.1 % postoperative . Factors significantly associated with SSI were high degree of wound contamination , prolonged preoperative hospital stay , emergency operation , and prolonged duration of operation . CONCLUSION Overall SSI rates were less than the average NNIS rates . The causative pathogens of SSI were different from those of other reports . There was a crucial proportion of operations that did not comply with the antibiotic guidelines . The risk factors for SSI identified in this study were consistent with most other reports Purpose The high incidence of infectious complications in ulcerative colitis ( UC ) is generally recognized to be due to several factors related to a compromised host . In our previous study , a high dose of corticosteroid was shown to be a risk factor for surgical site infection ( SSI ) . Recently , infliximab ( IFX ) has been used for refractory UC . In this study , the effect of IFX on the occurrence of infectious postoperative complications for UC was evaluated , because it remains controversial . Method A total of 196 UC patients who underwent laparotomy between January 2010 and September 2012 were included . Possible factors related to complications were analyzed to identify significant predictors . Results Twenty-two patients had IFX before surgery . The overall incidence of SSI was 47/196 ( 24.0 % ) . The incidence of infections , including SSI and other infections , was 69/196 ( 35.2 % ) . On multivariate analysis , national nosocomial infection surveillance ( NNIS ) risk index ≥2 ( p<0.01 ) and preoperative prednisolone dose ≥0.2 mg/kg/day ( p = 0.01 ) were identified as independent risk factors for overall SSI ; NNIS risk index ≥2 ( p < 0.01 ) and duration from onset of UC ≥6.3 years ( p = 0.045 ) were identified as independent risk factors for incisional SSI ; contaminated wound class ( p < 0.01 ) , preoperative hospital stay ≥6 days ( p = 0.048 ) , severe/fulminant disease activity ( p = 0.04 ) , and pancolitis ( p = 0.02 ) were identified as independent risk factors for organ/space SSI ; and contaminated wound ( p < 0.01 ) , severe/fulminant disease activity ( p = 0.02 ) , and age at surgery ≥43 years ( p = 0.047 ) were identified as independent risk factors for total infectious complications . Conclusion IFX administration was not associated with infectious complications for UC surgery Objective : The objective of this study was to clarify the incidence and risk factors for developing incisional surgical site infection ( SSI ) in both elective colon and rectal surgery . Summary Background Data : SSI is a frequent complication after elective colorectal resection . The National Nosocomial Infection Surveillance system surveys all colorectal surgeries together , without differentiating the type of colorectal surgery performed . However , rectal surgery may have a higher risk for SSI , and identifying risk factors that are more specific to each procedure would be more predictive . Methods : We conducted prospect i ve SSI surveillance of all elective colorectal resections performed by a single surgeon in a single institution from November 2000 to July 2004 . The data for colon and rectal surgeries were collected separately . The outcome of interest was incisional SSI . Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery . Results : A total of 556 colorectal resections , consisting of 339 colon and 217 rectal surgeries , were admitted to the program . The incisional SSI rates in colon and rectal surgeries were 9.4 % and 18.0 % , respectively ( P = 0.0033 ) . Risk factors for developing incisional SSI in colon surgery were ostomy closure ( OR = 7.3 ) and lack of oral antibiotics ( OR = 3.3 ) , while in rectal surgery , risk factors were preoperative steroids ( OR = 3.7 ) , preoperative radiation ( OR = 2.8 ) , and ostomy creation ( OR = 4.9 ) . Conclusions : Colon and rectal surgeries differ with regard to incidence and risk factors for developing incisional SSI . SSI surveillance for such surgeries should be performed separately , as this should lead to more efficient identification of risk factors and a reduction in SSI BACKGROUND The purpose of the study was to investigate allogeneic blood transfusion ( ABT ) and preoperative anemia as risk factors for surgical site infection ( SSI ) . STUDY DESIGN AND METHODS A prospect i ve , observational cohort of 5873 consecutive general surgical procedures at Basel University Hospital was analyzed to determine the relationship between perioperative ABT and preoperative anemia and the incidence of SSI .  ABT was defined as transfusion of leukoreduced red blood cells during surgery and anemia as hemoglobin concentration of less than 120 g/L before surgery . Surgical wounds and result ing infections were assessed to Centers for Disease Control st and ards . RESULTS The overall SSI rate was 4.8 % ( 284 of 5873 ) . In univariable logistic regression analyses , perioperative ABT ( crude odds ratio [ OR ] , 2.93 ; 95 % confidence interval [ CI ] , 2.1 to 4.0 ; p < 0.001 ) and preoperative anemia ( crude OR , 1.32 ; 95 % CI , 1.0 to 1.7 ; p = 0.037 ) were significantly associated with an increased odds of SSI . After adjusting for 13 characteristics of the patient and the procedure in multivariable analyses , associations were substantially reduced for  ABT  ( OR , 1.25 ; 95 % CI , 0.8 to 1.9 ; p = 0.310 ; OR , 1.07 ; 95 % CI , 0.6 to 2.0 ; p = 0.817 for 1 - 2 blood units and > or=3 blood units , respectively ) and anemia ( OR , 0.91 ; 95 % CI , 0.7 to 1.2 ; p = 0.530 ) . Duration of surgery was the main confounding variable . CONCLUSION Our findings point to important confounding factors and strengthen existing doubts on leukoreduced ABT during general surgery and preoperative anemia as risk factors for SSIs BACKGROUND Abdominal surgical site infections ( SSI ) cause substantial morbidity and mortality for patients undergoing operative procedures . We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo ( UCCK ) . METHODOLOGY Prospect i ve surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006 . CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance ( HELICS ) protocol . RESULTS A total of 253 surgical interventions in 225 patients were evaluated . The median age of patients was 42 years and 55.1 % of them were male . The overall incidence rate of SSI was 12 % . Follow-up was achieved for 84.1 % of the procedures . For patients with an SSI , the median duration of hospitalization was 9 days compared with 4 days for those without an SSI ( p2 , use of antibiotic prophylaxis and NNIS class of > 2 were all significant at p < .001 . The SSI rates for the NNIS System risk classes 0 , 1 and 2 - 3 were 4.2 % , 46.7 % and 100 % , respectively . CONCLUSIONS SSI caused considerable morbidity among surgical patients in UCCK . Appropriate active surveillance and infection control measures should be introduced during preoperative , intra-operative , and postoperative care to reduce infection rates Background . Although risk factors for surgical site infection ( SSI ) after cardiovascular ( CV ) surgery have been well-documented among adults , few studies have been conducted in children . We performed a case-control study to identify risk factors for hospitalized SSI in children undergoing CV surgery .  Methods . National Nosocomial Infections Surveillance System criteria were used prospect ively to identify cases of hospitalized SSI in patients who underwent CV surgery . Seventy-nine patients who underwent CV surgery without hospitalized SSI were r and omly selected as controls . Cases were compared with controls to determine preoperative , intraoperative and postoperative risk factors for hospitalized SSI . Multivariable logistic regression was performed . Results . An SSI developed in 19 of the 826 patients who underwent CV surgery  ( 2.3 cases per 100 surgeries ) during the study period . Infection was limited to soft tissue in 12 , whereas deeper infection occurred in 7 . Causative agents included Staphylococcus aureus ( 11 ) , coagulase-negative Staphylococcus ( 5 ) and Escherichia coli ( 2 ) . One patient did not have a pathogen isolated . In a multivariable analysis , duration of surgery ( odds ratio , 1.4 ; 95 % confidence interval , 1.2 to 1.8 ) and age < 1 month ( odds ratio , 14 ; 95 % confidence interval , 3.3 to 58.4 ) were independently associated with SSI . Conclusions . Age < 1 month and longer duration of surgery were independently associated with hospitalized SSI after CV surgery in children BACKGROUND CONTEXT Surgical site infection ( SSI ) is one of the most serious complications of spine surgery . Its predisposing factors , especially in routine surgeries , are less reported . However , a number of patient- and procedure-related risk factors could be avoided or at least determined preoperatively . Moreover , the patient-specific risk for SSI could be estimated before the elective surgery . PURPOSE The aim of the present study was to analyze the preoperatively determinable risk factors for SSI in patients who require elective routine surgery related to lumbar disc degeneration and to build a multivariable model for the individual risk prediction . STUDY DESIGN Analysis of prospect ively collected st and ardized clinical data and the validation of the results on an independent prospect i ve cohort were performed . PATIENT SAMPLE One thous and thirty ( N=1,030 ) patients were included in the study . All subjects underwent primary lumbar single- or two-level decompression , microdiscectomy , or instrumented fusion .  OUTCOME MEASURES Occurrence of an SSI defined according to the current Centers for Disease Control and Prevention guidelines that required surgical or nonsurgical therapy . METHODS The effect of preoperative patient characteristics , comorbidities , disease history , and invasiveness of the elective surgery on the risk of SSI was determined in uni- and multivariate logistic regression models in the test cohort ( N=723 ) . The performance of the final multivariable regression model was assessed by measuring its discriminative ability ( c-index ) in receiver operating characteristic analysis . Performance of the multivariable risk estimation model was tested on the validation ( N=307 ) cohort . RESULTS The prevalence of SSI was 3.5 % and 3.9 % in the test and in the validation cohorts , respectively . The final multivariable regression model predictive ( p=.003 ) for SSI contained the patient 's age , body mass index ( BMI ) , and the presence of 5 comorbidities , such as diabetes , ischemic heart disease , arrhythmia , chronic liver disease , and autoimmune disease as risk factors . The c-index of the model was 0.71 , showing good discriminative ability , and it was confirmed by the data of the independent validation cohort ( c=0.72 ) . CONCLUSIONS Predisposing factors for SSI were older age , higher BMI , and the presence of certain comorbidities in the present study . The cumulative number of risk factors significantly associated with the increasing risk for an SSI ( p<.0001 ) . Our model needs further validation but it may be used for individual risk assessment and reduction in the future Introduction In 2010 a care bundle was introduced by the Department of Health ( DH ) to reduce  surgical site infections ( SSIs ) in Engl and . To date , use of the care bundle has not been evaluated despite incorporating interventions with re source implication s. The aim of this study was to evaluate the DH SSI care bundle in open colorectal surgery . Methods A prospect i ve cohort design was used at two teaching hospitals in Engl and . The baseline group consisted of 127 consecutive patients having colorectal surgery during a 6-month period while the intervention group comprised 166 patients in the subsequent 6 months .  SSI and  care bundle compliance data were collected using dedicated surveillance staff . Results Just under a quarter ( 24 % ) of the patients in the baseline group developed a SSI compared with just over a quarter ( 28 % ) in the care bundle group ( p>0.05 ) . However , compliance rates with individual interventions , both before and after the implementation of the bundle , were similar . Interestingly , in only 19 % of cases was there compliance with the total care bundle . The single intervention that showed an associated reduction in SSI was preoperative warming ( p=0.032 ) . Conclusions The DH care bundle did not reduce SSIs after open colorectal surgery . Despite this , it is not possible to state that the bundle is ineffective as compliance rates before and after bundle implementation were similar . All studies evaluating the effectiveness of care bundles must include data for compliance with interventions both before and after implementation of the care bundle ; poor compliance may be one of the reasons for the lower than expected reduction of SSIs BACKGROUND Surveillance of surgical site infection ( SSI ) is one of the most effective methods for decreasing the incidence . We determined the risk factors for SSI and the effect of a one-year surveillance program on the rate at a tertiary-care center . METHODS The annual SSI rate before the study period was determined in a preliminary study . Risk factors related to SSI , the bacteria cultured from infected sites , and the effect of surveillance were then analyzed prospect ively . Risk factors were determined by logistic regression analysis , and 95 % confidence intervals were calculated . RESULTS The incidence of SSI decreased from 12.8 % before the study to 8.8 % at the end of the surveillance period . There were 90 SSIs ( 8.8 % ) in 1,017 procedures during the study period , most of which ( 77 ; 69 % ) were detected during the hospital stay . The distribution of superficial incisional , deep incisional , and organ/space SSI was 61.1 % , 33.4 % , and 5.5 % , respectively . Prolonged preoperative hospital stay ( > 8 days ) , abdominal incision , early preoperative hair removal , inappropriate antimicrobial prophylaxis , whole blood transfusion , famotidine treatment , repair with mesh , age > 75 years , wound contamination , high American Society of Anesthesiologists score , malnutrition , diabetes mellitus , emergency surgery , obesity , and coexistent infection proved to be independent risk factors for SSI , whereas the skin closure technique , patient sex , presence of malignancy , smoking history , and duration of operation were not . Staphylococcus aureus and Escherichia coli were the bacteria isolated most frequently . Six infected patients ( 5.4 % ) died , four because of SSI . Development of SSI increased hospital expenses by around 600 US dollars per patient . CONCLUSION Surveillance even for one year decreases the incidence of SSI BACKGROUND We sought to identify risk factors for surgical site infections ( SSI ) in children undergoing cardiac surgery . METHODS A matched case-control study was conducted in the Children 's Hospital Boston Cardiovascular Program . Surgical site infections were identified for 3 years ( 2004 to 2006 ) . We identified two r and omly selected control patients who underwent cardiac surgery within 7 days of each index case .  Univariate and multivariate conditional logistic regression analyses were used to identify risk factors for SSI . In a secondary analysis , risk factors for organ space SSI ( mediastinitis ) were sought . Secondary analyses were also conducted using only those variables known preoperatively . RESULTS Seventy-two SSI and 144 controls were included . Independent risk factors for any type of SSI were age younger than 1 year ( adjusted odds ratio , 2.28 ; 95 % confidence interval , 1.18 to 4.39 ) and duration of cardiopulmonary bypass greater than 105 minutes ( adjusted odds ratio , 1.92 ; 95 % confidence interval , 1.02 to 3.62 ) . Independent risk factors for organ space SSI were aortic cross-clamp time greater than 85 minutes ( adjusted odds ratio , 5.61 ; 95 % confidence interval , 1.06 to 29.67 ) and postoperative exposure to at least three separate red blood cell transfusions ( adjusted odds ratio , 7.87 ; 95 % confidence interval , 1.63 to 37.92 ) . When only those potential risk factors known preoperatively were considered , age younger than 1 year independently predicted the subsequent development of any type of SSI , and preoperative hospitalization independently predicted the subsequent development of organ space SSI . CONCLUSIONS Younger patients undergoing longer surgical procedures and those requiring more postoperative blood transfusions are at greatest risk for SSI . Additional preventive strategies , including restrictive blood transfusion policies , warrant further investigation STUDY OBJECTIVES To evaluate the effects of intraoperative skin-surface warming with and without 1 hour of preoperative warming , in preventing intraoperative hypothermia , and postoperative hypothermia , and shivering , and in offering good conditions to early tracheal extubation . DESIGN Prospect i ve , r and omized , blind study . SETTING Teaching hospital . PATIENTS 30 ASA physical status I and II female patients scheduled for elective abdominal surgery . INTERVENTIONS Patients received st and ard general anesthesia . In 10 patients , no special pre caution s were taken to avoid hypothermia . Ten patients were su bmi tted to preoperative and intraoperative active warming . Ten patients were only warmed intraoperatively . MEASUREMENTS AND MAIN RESULTS Temperatures were recorded at 15-minute intervals . The patients who were warmed preoperatively and intraoperatively had core temperatures significantly more elevated than the other patients during the first two hours of anesthesia . All patients warmed intraoperatively were normothermic only at the end of the surgery . The majority of the patients warmed preoperatively and intraoperatively or intraoperatively only were extubated early , and none had shivering . In contrast , five unwarmed patients shivered . CONCLUSIONS One hour of preoperative warning combined with intraoperative skin-surface warming , not simply intraoperative warming alone , avoided hypothermia caused by general anesthesia during the first two hours of surgery . Both methods prevented postoperative hypothermia and shivering and offered good conditions for early tracheal extubation Background Surgical site infections ( SSI ) following pancreatoduodenectomy ( PD ) contribute to adverse perioperative and long-term outcomes . Hence , the need to determine the modifiable factors related to their causation . Aim To identify demographic , nutritional , surgical and histopathological factors significantly associated with incisional SSIs . Methods A retrospective analysis of a prospect ively maintained data base of consecutive patients who underwent PD for pancreatic and periampullary lesions at a tertiary care referral centre , between April 2010 and June 2014 was carried out . Patients were divided into two groups based on the SSIs ( Group 1—With SSI ; Group 2—No SSI ) . All patients were administered three , once daily doses of Ertapenem ( 1 g ) as follows : within 1 h prior to induction , and on day 1 and day 2 following surgery . No further antibiotics were given prior to discharge unless clinical ly indicated . Results 35 out of 277 patients ( 12.6 % ) developed SSIs . No demographic ( age , sex , BMI ) , nutritional ( serum albumin ) , surgical ( pancreatic duct size and texture , surgical duration and intraoperative blood transfusions ) and histopathological factors ( malignancy vs. benign ) were noted between the two groups . However , SSIs were significantly higher in patients with endocrine co-morbidities ( other than diabetes mellitus ) , in those patients who had undergone prior ERCP and stenting , as well as an end-to-side pancreaticojejunostomy . Patients with diabetes mellitus had a significantly lower incidence of wound infections ( P = .014 ) . Conclusion Preoperative ERCP and stenting , end-to-side PJ and the presence of non-diabetic endocrine co-morbidity may result in a significantly higher risk of SSIs . Further studies targeting these patient sub population s are warranted to enable a better underst and ing of how these factors contribute to the incidence of SSIs following PD Background Surgical site infections ( SSI ) remain a major clinical problem in terms of morbidity , mortality , and hospital costs . Nearly 60 % of SSI diagnosis occur in the postdischarge period . However , literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence . A national prospect i ve multicenter study was conducted with the aim of assessing the incidence of both in-hospital and postdisharge SSI , and the associated risk factors . Methods In 2002 , a one-month , prospect i ve national multicenter surveillance study was conducted in General and Gynecological units of 48 Italian hospitals . Case ascertainment of SSI was carried out using st and ardized surveillance methodology . To assess potential risk factors for SSI we used a conditional logistic regression model . We also reported the odds ratios of in-hospital and postdischarge SSI . Results SSI occurred in 241 ( 5.2 % ) of 4,665 patients , of which 148 ( 61.4 % ) during in-hospital , and 93 ( 38.6 % ) during postdischarge period . Of 93 postdischarge SSI , sixty-two ( 66.7 % ) and 31 ( 33.3 % ) were detected through telephone interview and question naire survey , respectively . Higher SSI incidence rates were observed in colon surgery ( 18.9 % ) , gastric surgery ( 13.6 % ) , and appendectomy ( 8.6 % ) . If considering risk factors for SSI , at multivariate analysis we found that emergency interventions , NNIS risk score , pre-operative hospital stay , and use of drains were significantly associated with SSI occurrence . Moreover , risk factors for total SSI were also associated to in-hospital SSI . Additionally , only NNIS , pre-operative hospital stay , use of drains , and antibiotic prophylaxis were associated with postdischarge SSI . Conclusion Our study provided information on risk factors for SSI in a large population in general surgery setting in Italy . St and ardized postdischarge surveillance detected 38.6 % of all SSI . We also compared risk factors for in-hospital and postdischarge SSI , thus providing additional information to that of the current available literature . Finally , a large amount of postdischarge SSI were detected through telephone interview . The evaluation of the cost-effectiveness of the telephone interview as a postdischarge surveillance method could be an issue for further research BACKGROUND Two-thirds of surgical site infections ( SSI ) because of Staphylococcus aureus are caused by Methicillin resistant Staphylococcus aureus ( MRSA ) . This study was done to assess the efficacy of topical 2 % mupirocin with 2 % chlorhexidine gluconate body wash in decolonizing MRSA and its impact in preventing SSI because of MRSA . The various risk factors associated with MRSA carriers and SSI were also studied because of paucity of data in the developing world . METHODS We did a non-r and omised interventional trial in 602 patients undergoing elective general surgical operations . All patients in case ( 297 ) group were screened for MRSA and those positive were decolonised with topical 2 % mupirocin calcium ointment and daily baths with 2 % chlorhexidine antiseptic solution for 5 days . Control ( 305 ) group patients underwent surgery without decolonisation . Postoperatively , all patients were followed up for SSI for 30 days . RESULTS Prevalence of MRSA carriers was 7.5 % with decolonisation rate of 95.2 % . The SSI incidence was 21.3 % . The significant risk factors for SSI were type of anaesthesia ( p = 0.002 ) , duration of surgery ( p = 0.001 ) and preoperative hospital stay ( p = 0.001 ) . There was a significant association between MRSA carrier positivity at the time of surgery and SSI ( p = 0.041 ) . CONCLUSIONS There was no reduction in rate of SSI or other nosocomial infections in patients undergoing elective general surgical operations following preoperative MRSA decolonisation with 2 % mupirocin and 2 % chlorhexidine gluconate in MRSA carriers . MRSA carrier status was a significant risk factor for SSI but not for other nosocomial infections BACKGROUND The optimal method of reducing the risk of surgical site infection ( SSI ) after dermatologic surgery is unclear . Empiric , preoperative antibiotic use is common practice but lacks supporting evidence for its efficacy in preventing SSI . Risk stratification for patients at high risk of postoperative SSI based on a nasal swab is a viable strategy when coupled with topical decolonization for positive carriers . We compared the rates of infection in patients undergoing Mohs micrographic surgery ( MMS ) with nasal carriage of Staphylococcus aureus who received oral antibiotics or topical decolonization .  METHODS A r and omized , controlled trial with 693 patients was conducted over a 30‐week period at a single surgical practice . Patients were stratified into nasal carriers or noncarriers of S. aureus based on a preoperative nasal swab . Nasal carriers of S. aureus were r and omized to receive topical decolonization with intranasal mupirocin twice daily plus 4 % chlorhexidine gluconate body wash daily for 5 consecutive days before surgery or statim pre‐ and postoperative doses of oral cephalexin . RESULTS One hundred seventy‐nine patients ( 25.8 % ) were identified as carriers of S. aureus . Ninety received topical decolonization , and 89 received oral antibiotics . These groups were compared with a swab‐negative Mohs surgical cohort over the same time period . There were no significant differences between the groups in terms of demographic characteristics or comorbidities . Nine percent of patients receiving oral antibiotic prophylaxis and 0 % receiving topical decolonization developed early SSI ( p = .003 ) . CONCLUSION In patients with demonstrable carriage of S. aureus , topical decolonization result ed in fewer SSI than in patients receiving perioperative oral antibiotics . Antibiotics should be reserved for clinical ly suspected and swab‐proven infections rather than being prescribed empirically . Further efforts should be directed toward optimizing endogenous risk factor control for all patients presenting for MMS Background No data currently exist about use of antibiotics to prevent surgical site infections ( SSI )  among patients undergoing appendectomy in Thail and . We therefore examined risk factors , use , and efficacy of prophylactic antibiotics for surgical site infection SSI among patients with uncomplicated open appendectomy . Methods From July 1 , 2003 to June 30 , 2004 we conducted a prospect i ve cohort study in eight hospitals in Thail and . We used the National Nosocomial Infection Surveillance ( NNIS ) system criteria to identify SSI associated with appendectomy . We used logistic regression analysis to obtain relative risk estimates for predictors of SSI . Results Among 2139 appendectomy patients , we identified 26 SSIs , yielding a SSI rate of 1.2 infections/100 operations . Ninety-two percent of all patients ( 95 % CI , 91.0–93.3 ) received antibiotic prophylaxis . Metronidazole and gentamicin were the two most common antibiotic agents , with a combined single dose administered in 39 % of cases . In 54 % of cases , antibiotic prophylaxis was administered for one day . We found that a prolonged duration of operation was significantly associated with an increased SSI risk . Antibiotic prophylaxis was significantly associated with a decreased risk of SSI regardless of whether the antibiotic was administered preoperatively or intraoperatively . Compared with no antibiotic prophylaxis , SSI relative risks for combined single-dose of metronidazole and gentamicin , one-day prophylaxis , and multiple-day antibiotic prophylaxis were 0.28 ( 0.09–0.90 ) , 0.30 ( 0.11–0.88 ) and 0.32 ( 0.10–0.98 ) , respectively . ConclusionS ingle-dose combination of metronidazole and gentamicin seems sufficient to reduce SSIs in uncomplicated appendicitis patients despite whether the antibiotic was administered preoperatively or intraoperatively Abstract Background : Abdominal surgeries have high rates of surgical site infections ( SSIs ) , contributing to increased morbidity and mortality and costs for hospitalization . The aim of this study was to determine the SSI incidence rates and risk factors after  abdominal surgeries .  Methods : This prospect i ve cohort study included all patients undergoing abdominal surgeries between 2005 and 2007 in the Western Galilee Medical Center in Nahariya , Israel .  SSI incidence rates were calculated per 100 operations . Odds ratios ( ORs ) were estimated for each risk factor using univariate and multivariate analyses by logistic regression models . Results : Among 302 patients in the study cohort , the total SSI incidence rate was 22.2 % . The univariate analysis defined 13 variables significantly associated with SSI : age > 60 years , lower functional status , diabetes mellitus , congestive heart failure , immunocompromising underlying disease , treatment with chemotherapy and other immunosuppressive medications , impaired immune system open cholecystectomy , laparotomy , an American Society of Anesthesiologists ( ASA ) score > 2 , drain insertion , and ‘ dirty wound ’ classification . In multivariate regression analysis , treatment with immunosuppressive medications ( OR = 2.5 , 95 % confidence interval ( CI ) = 1.099–143.443 ) , open cholecystectomy ( OR = 2.25 , 95 % CI = 2.242–40.109 ) , and dirty wound classification ( OR = 2.179 , 95 % CI = 3.80–20.551 ) were significantly associated with SSI . Conclusions : The significant risk factors defined should be addressed preoperatively to decrease the risk for SSI . Wound surveillance in the post-discharge period is necessary for correct estimation of SSI rates
The results of this study suggest that preoperative warming can reduce rates of SSI after surgery .
OBJECTIVE To determine whether preoperative warming can reduce the risk of surgical site infection ( SSI ) after surgery .
BACKGROUND Intraoperative hypothermia is a risk factor for the occurrence of  SSI in patients after surgery .
However , the effectiveness of preoperative warming in reducing the incidence of the condition remains unclear .