title: Surgical site infections in orthopedic patients: prospective cohort study.
abstract: OBJECTIVE
  To estimate the incidence rate and risk factors of surgical site infections in the orthopedic wards in a major teaching hospital in Serbia.
  
  
  METHODS
  A 6-month prospective cohort study, with 30 days of patient follow-up after surgery, was conducted at the teaching hospital in Belgrade. We collected patients' basic demographic data and data on underlying disease status, surgical procedures, preoperative preparation of patients, and antibiotic prophylaxis. The National Nosocomial Infections Surveillance (NNIS) risk index was computed for each patient. Descriptive and logistic regression analyses were performed to determine risk factors for surgical site infections.
  
  
  RESULTS
  Assessment of 277 patients after operation revealed surgical site infection in 63 patients. In 3 (4.8%) of them, surgical site infections were detected after hospital discharge. The overall incidence rate of surgical site infections was 22.7% (95% confidence interval [95% CI], 17.5-29.1). The incidence increased from 13.2% in clean wounds to 70.0% in dirty wounds. The rates of surgical site infection for the NNIS risk index classes 0 to 3 were 8.1% (13 of 161), 36.4% (32 of 88), 63.0% (17 of 27), and 100% (1 of 1) (P<0.001; chi2 test). Multivariate logistic regression analysis identified the following independent risk factors for surgical site infections: greater number of persons in the operating room (odds ratio [OR], 1.28; 95% CI, 1.02-1.60), contaminated or dirty wounds (OR, 12.09; 95% CI, 5.56-26.28), and American Society of Anesthesiologists' (ASA) score >2 (OR, 3.47; 95% CI, 1.51-7.95). In patients who were shaved with a razor, the period of 12 or more hours between shaving and intervention was also an independent risk factor (OR, 2.77; 95% CI, 1.22-6.28).
  
  
  CONCLUSIONS
  There is a high incidence of surgical site infections in orthopedic patients in Serbia in comparison with developed countries and some developing countries. Points for intervention could be reduction of personnel during surgery, better treatment of wounds, decreasing ASA score, and reduction of the time between surgical site shaving and the intervention.
authors.affiliation: Ljiljana Markovic-Denic, Institute of Epidemiology, School of Medicine, Visegradska 26, 11000 Belgrade, Serbia, ljiljana_denic@batut.org.yu.
authors.forename: Jadranka
authors.initials: J
authors.lastname: Maksimović
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Marković-Denić
authors.forename: Marko
authors.initials: M
authors.lastname: Bumbasirević
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinković
authors.forename: Hristina
authors.initials: H
authors.lastname: Vlajinac
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D011159:Population Surveillance; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D015022:Yugoslavia