1. Surgical Site Infection Perioperative Hypothermia

5. The SSI phenomena: A simply complex problem

6. Impact of SSI InfectedUninfected Mortality (in-hospital) 7.8%3.5% ICU admission 29%18% Readmission41%7% Median initial LOS 11d6d Median total LOS 18d7d Initial excess cost +$3,644 (median) Total excess cost +$5,038 (median) *Pairs matched for procedure, NNIS index, age Kirkland. Infect Control Hosp Epidemiol. 1999;20:725. Prospective, case-controlled study of 22,742 patients undergoing inpatient surgical procedures between 1991–1995.

7. Appropriate hair removal No hair removal or clipping Clipping time as close as possible to incision time Shaving shown to cause microscopic breakage in the epithelial barrier, leading to bacterial contamination of the wound

9. Perioperative Prophylactic Antibiotics Classen. NEJM. 1992;328:281.

10. Normothermia

12. Perioperative hypothermia GA alters central thermoregulation Thermoregulatory responses are triggered after 2-3ºC of hypothermia (±34ºC) Core temperature decreases by 1ºC within 30 minutes of induction Heat production decreases by 5%/ºC in the absence of shivering Enhanced heat loss

13. Normothermia for colorectal surgery A Kurz, NEJM 1996; 334:1209-15 200 patients, double-blind study Followed for 2 weeks 34.7±0.6 Celsius VS 36.6±0.5 Celsius SSI 18.8% VS 5.8% (p=0.009) Sutures were removed one day later (p=0.002) Hospital LOS prolonged by 2.6 days (p=0.01)