title: Analyzing the risk factors influencing surgical site infections: the site of environmental factors.
abstract: BACKGROUND
  Addressing surgical site infection (SSI) is accomplished, in part, through studies that attempt to clarify the nature of many essential factors in the control of SSI. We sought to examine the link between multiple risk factors, including environmental factors, and SSI for prevention management.
  
  
  METHODS
  We conducted a longitudinal prospective study to identify SSIs in all patients who underwent interventions in 2014 in 8 selected hospitals on the Mediterranean coast of Spain. Risk factors related to the operating theatre included level of fungi and bacterial contamination, temperature and humidity, air renewal and differential air pressure. Patient-related variables included age, sex, comorbidity, nutrition level and transfusion. Other factors were antibiotic prophylaxis, electric versus manual shaving, American Society of Anaesthesiologists physical status classification, type of intervention, duration of the intervention and preoperative stay.
  
  
  RESULTS
  Superficial SSI was most often associated with environmental factors, such as environmental contamination by fungi (from 2 colony-forming units) and bacteria as well as surface contamination. When there was no contamination in the operating room, no SSI was detected. Factors that determined deep and organ/space SSI were more often associated with patient characteristics (age, sex, transfusion, nasogastric feeding and nutrition, as measured by the level of albumin in the blood), type of intervention and preoperative stay. Antibiotic prophylaxis and shaving with electric razor were protective factors for both types of infection, whereas the duration of the intervention and the classification of the intervention as "dirty" were shared risk factors.
  
  
  CONCLUSIONS
  Our results suggest the importance of environmental and surface contamination control to prevent SSI.
authors.affiliation: From the Department of Preventive Medicine, University of Valencia, Spain (Alfonso-Sanchez); the Department of Nursing, University of Valencia, Valencia, Spain (Martinez); the Preventive Medicine Service, University Clinic Hospital, Valencia, Spain (Martín-Moreno, González); and the Department of Preventive Medicine, Hospital Virgen de Arrixaca, Murcia (Botía).
authors.forename: Jose L
authors.initials: JL
authors.lastname: Alfonso-Sanchez
authors.affiliation: From the Department of Preventive Medicine, University of Valencia, Spain (Alfonso-Sanchez); the Department of Nursing, University of Valencia, Valencia, Spain (Martinez); the Preventive Medicine Service, University Clinic Hospital, Valencia, Spain (Martín-Moreno, González); and the Department of Preventive Medicine, Hospital Virgen de Arrixaca, Murcia (Botía).
authors.forename: Isabel M
authors.initials: IM
authors.lastname: Martinez
authors.affiliation: From the Department of Preventive Medicine, University of Valencia, Spain (Alfonso-Sanchez); the Department of Nursing, University of Valencia, Valencia, Spain (Martinez); the Preventive Medicine Service, University Clinic Hospital, Valencia, Spain (Martín-Moreno, González); and the Department of Preventive Medicine, Hospital Virgen de Arrixaca, Murcia (Botía).
authors.forename: Jose M
authors.initials: JM
authors.lastname: Martín-Moreno
authors.affiliation: From the Department of Preventive Medicine, University of Valencia, Spain (Alfonso-Sanchez); the Department of Nursing, University of Valencia, Valencia, Spain (Martinez); the Preventive Medicine Service, University Clinic Hospital, Valencia, Spain (Martín-Moreno, González); and the Department of Preventive Medicine, Hospital Virgen de Arrixaca, Murcia (Botía).
authors.forename: Ricardo S
authors.initials: RS
authors.lastname: González
authors.affiliation: From the Department of Preventive Medicine, University of Valencia, Spain (Alfonso-Sanchez); the Department of Nursing, University of Valencia, Valencia, Spain (Martinez); the Preventive Medicine Service, University Clinic Hospital, Valencia, Spain (Martín-Moreno, González); and the Department of Preventive Medicine, Hospital Virgen de Arrixaca, Murcia (Botía).
authors.forename: Francisco
authors.initials: F
authors.lastname: Botía
mesh_terms: D000368:Aged; D001419:Bacteria; D004866:Equipment Contamination / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005658:Fungi; D006801:Humans; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D009873:Operating Rooms / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology