Impact of intraoperative behavior on surgical site infections.
BACKGROUND
The aim of this study was to identify intraoperative risk factors for surgical site infections (SSIs), which are accessible to interventions. We evaluated the effect of extensive intraoperative antiseptic measures and the impact of the behavior of members of the surgical team on SSIs.


METHODS
Standard versus extensive antiseptic measures were randomly assigned in 1,032 surgical patients. The adherence to principles of asepsis by members of the surgical team was assessed prospectively.


RESULTS
The rate of SSI was 14% with standard antiseptic measures and 15% with extensive measures (P = .581). Multivariate analysis identified following independent risk factors: lapses in discipline (odds ratio [OR] 2.02, confidence interval [CI] 1.05-3.88), intestinal anastomosis (OR 6.74, CI 3.42-13.30), duration of operation more than 3 hours (OR 3.34, CI 1.82-6.14), and body mass index >30 kg/m2 (OR 1.98, CI 1.22-3.20).


CONCLUSIONS
Extensive measures of antisepsis did not reduce the incidence of SSI. A lapse to adhere to principles of asepsis was identified as an independent risk factor for the development of SSI (ClinicalTrials.gov number, NCT00555815).
Beldi
Guido
G
Department of Visceral and Transplant Surgery, Bern, Switzerland. guido.beldi@insel.ch
Bisch-Knaden
Sonja
S
Banz
Vanessa
V
Mühlemann
Kathrin
K
Candinas
Daniel
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003107:Colorectal Surgery; D004866:Equipment Contamination / Q000517:prevention & control; D004865:Equipment and Supplies, Hospital; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007422:Intestines / Q000601:surgery; D007430:Intraoperative Care; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009873:Operating Rooms; D010348:Patient Care Team; D011206:Povidone-Iodine / Q000008:administration & dosage; D011446:Prospective Studies; D011482:Protective Devices; D000077331:Ringer's Solution; D012307:Risk Factors; D013242:Sterilization; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013696:Temperature; D013997:Time Factors
D000891:Anti-Infective Agents, Local; D007552:Isotonic Solutions; D000077331:Ringer's Solution; D011206:Povidone-Iodine