title: Adherence to surgical site infection guidelines in Italian cardiac surgery units.
abstract: BACKGROUND
  Data on the adherence to surgical site infection (SSI) prevention guidelines in Italian cardiac surgery units are lacking.
  
  
  METHODS
  A multiple-choice questionnaire, structured into eight sections following the Centers for Disease Control 1999 (CDC) guidelines, was prepared and sent to 24 surgical units participating in a national study group (GIS-InCard); this units perform over 20% of all cardiac surgical procedures in Italy. Answers were stratified based upon the evidence of the recommendations: grade IA (ten questions), grade IB (52 questions), grade II (11 questions), and no recommendation (seven questions).
  
  
  RESULTS
  17 of the 24 units (72%) returned the questionnaire. Adherence to grade IA recommendations was 69 +/- 34%, with five units (29%) showing a > or =80% adherence. Adherence to grade IB and II was 65 +/- 26% and 71 +/- 28%, respectively. Adherence did not vary significantly depending on the evidence of the recommendation, i.e., grade IA, IB or II (p = 0.72). Low adherence levels to grade I recommendations were observed on hair removal: (1) it was performed systematically in all male patients (0% adherence), (2) it was performed on the morning of the intervention in 29% of centers, and (3) the method of hair removal was adequate in 41% of cases. Despite 94% of units having written guidelines on antibiotic prophylaxis, only 65% administered antibiotic prophylaxis with the correct timing - i.e., on anesthesia induction.
  
  
  CONCLUSIONS
  Adherence to CDC SSI guidelines in Italy is fair. The evidence of the recommendation does not influence adherence. Organizational improvements, especially those regarding hair removal and the timing of antibiotic prophylaxis, should be implemented in most hospitals.
authors.affiliation: Istituti Ospitalieri di Cremona, Italy. ange.pan@tiscali.it
authors.forename: A
authors.initials: A
authors.lastname: Pan
authors.forename: L
authors.initials: L
authors.lastname: Ambrosini
authors.forename: A
authors.initials: A
authors.lastname: Patroni
authors.forename: L
authors.initials: L
authors.lastname: Soavi
authors.forename: L
authors.initials: L
authors.lastname: Signorini
authors.forename: G
authors.initials: G
authors.lastname: Carosi
authors.forename: C
authors.initials: C
authors.lastname: Santini
mesh_terms: D000704:Analysis of Variance; D019072:Antibiotic Prophylaxis; D006348:Cardiac Surgical Procedures; D002487:Centers for Disease Control and Prevention, U.S.; D016009:Chi-Square Distribution; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006204:Hair Removal; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D009873:Operating Rooms / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D014481:United States