title: Impact of intraoperative behavior on surgical site infections.
abstract: 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).
authors.affiliation: Department of Visceral and Transplant Surgery, Bern, Switzerland. guido.beldi@insel.ch
authors.forename: Guido
authors.initials: G
authors.lastname: Beldi
authors.forename: Sonja
authors.initials: S
authors.lastname: Bisch-Knaden
authors.forename: Vanessa
authors.initials: V
authors.lastname: Banz
authors.forename: Kathrin
authors.initials: K
authors.lastname: Mühlemann
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
mesh_terms: 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
chemical_list: D000891:Anti-Infective Agents, Local; D007552:Isotonic Solutions; D000077331:Ringer's Solution; D011206:Povidone-Iodine