Class of 2012 Abstract / Specific Aims: The primary purpose of this study was to evaluate the time of vancomycin pre-operative surgical site infection prophylaxis administration relative to other scheduled antibiotic therapy at a tertiary care, academic medical center. The secondary purpose was to characterize the incidence of adverse events post-surgery that were associated with vancomycin therapy in patients who received both pre- operative scheduled vancomycin therapy and vancomycin for surgical site infection prophylaxis Methods: This descriptive study was a retrospective medical chart review of all patients over the age of 28 days who received vancomycin for surgical site infection prophylaxis between February 2011 and May 2011 at a tertiary care, academic medical center. This study was approved be the Institutional Review Board. The subject population included patients admitted to the hospital for at least 72 hours who received at least 48 hours of scheduled vancomycin (IV), daptomycin or linezolid therapy before index surgery and subsequently received surgical site infection prophylaxis with vancomycin. Main Results: Of the 20 subjects who meet the study inclusion criteria, 18 (90%) subjects received scheduled vancomycin doses within 48 hours prior to surgery, 5 (25%) subjects within 4 hours, and 4 (20%) subjects within 2 hours. No surgical site infections were reported. Conclusions: This was a pilot study to evaluate the timing of vancomycin surgical site infection prophylaxis doses with scheduled vancomycin, linezolid, and daptomycin. No adverse effects associated with surgical site infection prophylaxis were reported but the sample size is small and likely inadequate to detect this potential issue.

Purpose: Administration of a mechanical bowel preparation (MBP) has long been standard before colorectal surgery with the aim of preventing complications such as surgical site infection (SSI). Newer evidence suggests that MBP does not reduce the risk of infection and that oral antibiotic (OA) use may be important in reducing post-operative infectious complications, however, there is little evidence comparing MBP, OA, and combination preparations. Our goal was to determine the relationship between type of bowel preparation and SSI in patients undergoing elective colorectal resections Methods: All patients within the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database undergoing elective colorectal resections from 2012 to 2013 were identified. The primary outcomes of interest were: any post-operative SSI, wound SSI, and organ/space SSI. Secondary outcomes were anastomotic leak, post-operative ileus, cardiac complications, renal complications, death, unplanned readmission, and length of stay (LOS). Univariate models were used to compare frequencies of patient and surgical characteristics across types of bowel preparation, and propensity adjustment was used to study the relationship between type of bowel preparation and all outcomes of interest. Results: Among the study sample, 25.5% received no bowel preparation, 40.8% received MBP, 3.3% received OA, and 30.4% received OA+MBP. A total of 1,844 patients (9.5%) developed any type of post-operative SSI. 1,231 (6.4%) developed a wound SSI and 672 (3.5%) developed an organ/space SSI. MBP was not associated with a reduced risk of any type of SSI compared to no bowel preparation. Both OA and OA+MBP were significantly associated with a decreased risk of any SSI and wound SSI compared to both no preparation and compared to MBP. No differences were observed for any SSI or wound SSI between OA and OA+MBP. Compared to no preparation, OA+MBP was associated with a decreased risk of anastomotic leak and post-operative ileus. No differences were observed between MBP and OA, or between these preparation methods and no preparation, for these secondary outcomes. There were no significant associations between type of bowel preparation and cardiac or renal complications, mortality, or readmissions. Both OA and OA+MBP were associated with a reduction in LOS. Conclusion: These results suggest that a combination oral and mechanical bowel preparation may be most effective at preventing SSI after elective colorectal resection and that OA alone may also be effective. Future prospective studies comparing combination and OA preparations may be warranted to explore this relationship further. / Clinical Research and Translational Medicine

OBJECTIVE: Hospital systems and regulating agencies enforce strict guidelines barring personal items from entering the operating room (OR) - touting surgical site infections (SSIs) and patient safety as the rationale. We sought to determine whether or not evidence supporting this recommendation exists by reviewing available literature. BACKGROUND DATA: Rules and guidelines that are not evidence based may lead to increased hospital expenses and limitations on healthcare provider autonomy. METHODS: PubMed, Embase, Scopus, Cochrane Library, Web of Science, and CINAHL were searched in order to find articles that correlated personal items in the OR to documented SSIs. Articles that satisfied the following criteria were included: (1) studies looking at personal items in the OR, such as handbags, purses, badges, pagers, backpacks, jewelry phones, and eyeglasses, but not just OR equipment; and (2) the primary outcome measure was infection at the surgical site. RESULTS: Seventeen articles met inclusion criteria and were evaluated. Of the 17, the majority did not determine if personal items increased risk for SSIs. Only one article examined the correlation between a personal item near the operative site and SSI, concluding that wedding rings worn in the OR had no impact on SSIs. Most studies examined colonization rates on personal items as potential infection risk; however, no personal items were causally linked to SSI in any of these studies. CONCLUSION: There is no objective evidence to suggest that personal items in the OR increase risk for SSIs.

Höft- och knäprotesoperationer är idag en vanlig operation vid artros i höft- och knäled. Trotsminutiösa infektionsförebyggande förberedelser inför operationen drabbas ändå en delpatienter av postoperativa infektioner. Vid ortopedisk proteskirurgi är postoperativainfektioner ett direkt hot mot den nya inopererade leden och kan leda till långabehandlingstider som påverkar patientens livskvalitet under lång tid. Syftet med studien var att utforska patienters möjlighet till delaktighet i tidig upptäckt avpostoperativ infektion utifrån given information vid operation för höft- eller knäprotes. Semi-strukturerade intervjuer genomfördes med tio patienter med diagnostiserad postoperativinfektion efter höft- eller knäprotesoperation. Transkriberade intervjuer analyserades medinnehållsanalys. Journaler granskades för att beskriva patientens tidigare sjukdomar. Resultatet visade att första tecknen på infektion kan beskrivas med temat: Vad är normalt ochvad är inte normalt. Två kategorier beskriver patienternas Möjlighet till delaktighet ochHinder till delaktighet i det infektionsförebyggande arbete före, under och efter operation. Det handlade om hur patienten hade förstått eller inte förstått given information, vilketkategoriserades som subkategorier. Personcentrerad vård kan vara ett redskap för att stärka patienternas förutsättningar tilldelaktighet och ökar möjligheterna för att förhindra att vårdskador så som postoperativainfektioner uppstår. / Surgery with prosthetic joint replacement of the hip and knee in patients with osteoarthritis is a common procedure. Despite meticulous preparation prior to surgery, surgical site infections develop in some patients. A surgical site infection is a direct threat to the new implanted joint and can lead to long treatments that affect quality of life over time. The aim of this study was to explore patients´ participation in early detection of a surgical site infection based on the information given in conjunction to surgery for hip and knee replacement. Semi structured interviews were conducted with ten patients diagnosed with surgical site infection after hip or knee replacement surgery. Transcribed interviews were analyzed using content analysis. Medical records were reviewed to describe the patients´ comorbidity. The result showed that the first signs of infection can be described with the theme; What is normal and what is not normal? Two categories describe patients´ Possibility of participation and Barriers to participation in infection prevention before and after surgery. It was all about How the patient had understood or not understood the given information which was categorized as subcategories. Person-centered care can be a tool that enables patients´ possibilities to participate in their care and increases the possibilities to prevent adverse events such as surgical site infections.

Bakgrund: Postoperativa sårinfektioner drabbar ca 2,3 % av de patienter som genomgått ett kirurgiskt ingrepp i svensk hälso- och sjukvård. Dessa infektioner kan ge upphov till förlängd vårdtid, ytterligare kirurgiska ingrepp och ökad mortalitet. Postoperativa sårinfektioner innebär ett lidande för patienten samtidigt som det är kostsamt för sjukvården. Inom sjukvården används utarbetade arbetssätt för att minska riskerna för att patienten ska drabbas. Samtidigt utvecklas och studeras nya metoder i det preventiva arbetet mot postoperativa sårinfektioner, exempelvis suturer belagda med antibakteriella substanser. En av dessa är triklosanbelagda suturer. Dock råder viss oenighet om dess preventiva effekter och roll i det förebyggande arbetet mot postoperativa sårinfektioner. Syfte: Studiens syfte var att undersöka om suturer med beläggning av triklosan har en förebyggande effekt mot postoperativa sårinfektioner. Metod: Studien utformades som en systematisk litteraturstudie med metaanalys av 7 randomiserade kontrollerade studier. Dessa studier hade en uppföljningstid om 30 dagar samt använt bedömningskriterier för förekomst av postoperativa sårinfektioner enligt CDC, Centers for Disease Control and Prevention. Resultat: Inget statistiskt signifikant resultat kunde erhållas gällande triklosanbelagda suturers preventiva effekt mot postoperativa sårinfektioner. (RR=0,8, 95 % CI=0,63-1,02, p=0.07). Slutsats: Studien indikerar att triklosanbelagda suturer inte rutinmässigt bör användas i preventivt syfte mot postoperativa sårinfektioner. Ytterligare forskning behövs på området. / Background: Approximately 2,3 % of the patients undergoing surgery in Swedish healthcare develop surgical site infections. These infections are often associated with prolonged hospital stay, additional surgical procedures and increased mortality. Surgical site infections cause patient suffering and increase healthcare costs. In healthcare, standard guidelines and work methods are used to prevent patients from developing surgical site infections. New methods to reduce the risk of surgical site infections are being developed and studied, such as sutures with antibacterial coating. One of these is Triclosan-coated sutures. However, there is some disagreement on its preventive effects and role in reducing surgical site infections. Aim: The aim of this study was to investigate if Triclosan-coated sutures have a preventive effect against surgical site infections. Method: This study was conducted as a systematic literature review with meta-analysis of 7 RCT. These studies all had a follow up time of 30 days and used the criteria of CDC, Centers for Disease Control and Prevention, to identify surgical site infections. Result: This study showed no statistically significant results of Triclosan-coated sutures preventive effect against surgical site infections. (RR=0,8, 95 % CI=0,63-1,02, p=0.07). Conclusion: This study indicates that Triclosan-coated sutures should not be used routinely to prevent surgical site infections. More studies are needed.

Syftet för denna studie var att studera förekomsten av postoperativa sårinfektioner hos patienter som genomgått kärloperation med inguinal incision under åren 2008 till och med mars månad 2013. Undersöka skillnader gällande riskfaktorer inom studerad patientgrupp för förekomst av postoperativ sårinfektion samt studera om patienter som utfört endovaskulär metod under samma vårdtillfälle oftare drabbades av postoperativ sårinfektion än de patienter som inte genomgått endovaskulär metod under samma vårdtillfälle. Metoden som användes var granskning av patientjournaler efter utifrån studien utvalda specifika operationskoder. Granskningen av de 54 patientjournalerna skedde med hjälp av egenmodifierad tidigare använd granskningsmall. Studieresultatet visar att förekomsten av postoperativa sårinfektioner hos den studerade patientgruppen uppgår till 22,2 %. Skillnader mellan infektion och utförd endovaskulär metod kunde ses men inte påvisas med statistisk signifikans. Studien visade också att kvinnor oftare än män drabbas av postoperativ sårinfektion. Slutsatsen är att ungefär var femte patient i studien, som genomgått denna typ av kirurgi, ådrog sig en postoperativ sårinfektion och att många av dessa ledde till en kostsam postoperativ sårbehandling med Vacuum assisted closure, (VAC). / The purpose of this study was to investigate the incidence of postoperative wound infections in patients undergoing vascular surgery with inguinal incision in the years 2008 until March 2013. Examining differences in the risk factors in the studied group of patients occurrence of postoperative wound infection and to study whether patients who performed endovascular method during the same hospitalization more often suffered postoperative wound infection than patients who did not undergo endovascular method during the same hospitalization. The method used was the examination of patient records for the study, based on selected specific audit template. Study results show that the incidence of postoperative wound infections in the studied patient population amounts to 22,2 %. Differences between infection and performed endovascular method could be seen but not detected with statistical significance. The study also showed that women more often than men suffer from postoperative wound infection. The conclusion is that approximately one in five patients in the study who have undergone this type of surgery, suffered a postoperative wound infection and that many of these led to a costly postoperative wound Vacuum Assisted Closure (VAC).

Bakgrund: Flera studier beskriver vikten av att minimera dörröppningsfrekvensen på operationssalarna. Högre frekvens av dörröppningar leder till försämrad ventilation på operationssalen, vilket i sin tur kan leda till vårdrelaterade infektioner. Syfte: Syftet med denna studie var att på en operationsavdelning observera frekvensen av dörröppningar under pågående operation, varför och av vem de öppnades. Metod: Metoden var en kvantitativ deskriptiv observationsstudie med tvärsnittsdesign. Personalen på en operationsavdelning i Mellansverige observerades under pågående operationer. Observationerna utfördes sex vardagar i januari 2013 och valdes från operationsprogrammet. Resultat och slutsats: 22 observationstillfällen observerades, 11 från vardera konventionell respektive infektionskänslig kirurgi. Studien visade att dörröppningsfrekvensen var högre vid konventionell kirurgi jämfört med infektionskänslig. Dörröppningsfrekvensen varierade från en gång per minut till var 10:e minut vid konventionell kirurgi. Vid infektionskänslig kirurgi varierade dörröppningsfrekvensen från var 3:e minut till var 19:e minut. Den yrkesgrupp som utförde de flesta dörröppningarna var den cirkulerande personalen. Den största anledningen till dörröppningarna var hämtning av utrustning/material/instrument. Klinisk betydelse: Studien visar att dörröppningsfrekvensen vid konventionell kirurgi är högre än vid infektionskänslig kirurgi. För infektionskänslig kirurgi finns lokala riktlinjer. Däremot finns det inte vid konventionell kirurgi, där de kunde ha betydelse för att sänka dörröppningsfrekvensen. / Background: Several studies describe the importance of minimizing the frequency of door openings to the operating room. Higher frequency of door openings leads to impaired ventilation in the operating room, which in turn can lead to surgical site infections. Aim: The aim of this study was that in a surgical department observing the frequency of door openings during surgery, why and by whom they were opened. Method: The method was a quantitative descriptive observational study with cross-sectional design. The personnel in a surgical department in central Sweden were observed during operations. The observations were performed six weekdays in January 2013 and were selected from the surgical program. Results and conclusion: 22 observations were observed, 11 each from conventional and implant surgery. The study indicated that door openings were more frequent when comparing conventional surgery with implant surgery. The frequency of door openings varied from once per minute to every 10 minutes for conventional surgery. In implant surgery the frequency of door openings varied from every 3 minutes to every 19 minutes. The profession who carried out most door openings was the circulating staff. The main reason for the door openings was retrieval of equipment / materials / instruments. Clinical relevance: This study shows that the frequency of door openings was higher at conventional surgery than at implant surgery. For implant surgery there are local guidelines. However, there are none for conventional surgery, where they could play a role in lowering the frequencies of door openings.

Bakgrund: : Vårdrelaterade infektioner är kostsamma för vården och orsakar lidande förpatienten. Operationspersonal har en viktig uppgift att förebygga smittspridning och följahygienrutiner. Dessa är bland andra att använda rätt arbetskläder, arbeta aseptiskt och enligtbasala hygienrutiner samt att bibehålla steriliteten. Syfte: Syftet med studien var att observeraföljsamheten till aseptik och basala hygienrutiner på operationssal vid allmänkirurgiskt ingreppvid två sjukhus i Mellansverige. Metod: Studien var en observationsstudie med kvantitativansats. Observationerna genomfördes utifrån ett observationsprotokoll. Ingreppen somobserverades var av allmänkirurgisk karaktär och totalt tio observationer utfördes.Yrkeskategorier som ingår i operationsteamet observerades i olika arbetsmoment, såsomarbetskläder, insättning av PVK, preoperativ huddesinfektion och steril drapering. Följsamhetentill de olika momenten beräknades i procent. Resultat: Totalt tio observationer genomfördes. Dearbetsmoment som hade bäst följsamhet var arbetskläder, insättning av PVK, preoperativhuddesinfektion och steril drapering. I alla arbetsmoment som observerades var handdesinfektionden underkategori som hade sämst följsamhet. Slutsats: I samtliga av de sex arbetsmoment somobserverades i studien fanns brister gällande följsamhet till aseptik och basala hygienrutiner trotsatt vissa moment, såsom preoperativ huddesinfektion och steril drapering av operationsområdet,hade hög följsamhet. / Background: Hospital acquired infections are costly for health care and causes distress for thepatient. Operational staff have an important role in preventing the spread of infection and followhygiene procedures. These include using the proper work clothes, work aseptically and accordingto basic hygiene and to maintain sterility. Aim: The aim of the study was to observe adherence toaseptic technique and basic hygiene procedures in the operating theater for general surgery attwo hospitals in central Sweden. Method: The study was an observational study withquantitative approach. The observations were carried out on the basis of an observation protocol.The surgical intervention that were observed was of a general surgical nature and a total of tenobservations were performed. Professional categories included in the operating team wereobserved in different tasks, such as work clothes, insertion of PVK, preoperative skindisinfection and sterile draping. Adherence to the various elements was calculated in percent.Result: A total of ten observations were made. The observed tasks that had the best adherencewere working clothes, insertion of PVK, preoperative skin disinfection and sterile draping. Handdisinfection was the subcategory that had the lowest adherence of all observed tasks.Conclusion: In each of the six tasks that were observed in the study there were deficienciesregarding adherence to aseptic technique and basic hygiene despite some tasks, such aspreoperative skin disinfection and sterile draping of the surgical field, which had high adherence.

Submitted by VIVIANE CRISTINA BASTOS ARMEDE null (viviarmede@hotmail.com) on 2016-03-06T22:20:34Z No. of bitstreams: 1 ISC em Hopsitais de Pequeno Porte.pdf: 860887 bytes, checksum: f70f09c3db2d695fd142248c0d77d739 (MD5) / Approved for entry into archive by Sandra Manzano de Almeida (smanzano@marilia.unesp.br) on 2016-03-07T18:10:48Z (GMT) No. of bitstreams: 1 armede_vcb_me_bot.pdf: 860887 bytes, checksum: f70f09c3db2d695fd142248c0d77d739 (MD5) / Made available in DSpace on 2016-03-07T18:10:48Z (GMT). No. of bitstreams: 1 armede_vcb_me_bot.pdf: 860887 bytes, checksum: f70f09c3db2d695fd142248c0d77d739 (MD5) Previous issue date: 2016-02-22 / As Infecções Relacionadas à Assistência à Saúde (IRAS) são um problema de saúde pública de relevância global, e atingem com mais intensidade os países em desenvolvimento. No entanto, quase todas as informações disponíveis sobre incidência e preditores de IRAS procedem de estudos conduzidos em hospitais de ensino e/ou de grande porte. No Brasil, aproximadamente dois terços dos serviços hospitalares tem menos de 50 leitos, sendo classificados como hospitais de pequeno porte (HPP). Estes albergam intensa atividade cirúrgica e obstétrica, embora voltada a procedimentos de baixa complexidade. São portanto ambientes de risco para infecção do sítio cirúrgico (ISC). Nosso estudo foi delineado para abordar a incidência e os determinantes de ISC em pequenos hospitais. Analisamos uma coorte de pacientes submetidos a procedimentos cirúrgicos em três HPP localizados no interior do Estado de São Paulo. Cada cirurgia foi acompanhada presencialmente, sendo registrados dados dos pacientes e dos processos de trabalho. Ao mesmo tempo, foi aplicado checklist de indicadores de contaminação ambiental em centro cirúrgico. Os sujeitos da pesquisa foram acompanhados por um mês com ligações telefônicas para diagnóstico de infecção do sítio cirúrgico (ISC). Modelos de regressão logística foram aplicados para identificar, separadamente, preditores de ISC e a associação de tópicos do checklist com o risco infeccioso em cirurgias. Foi identificada uma incidência agregada de ISC de 8.1% nos hospitais do estudo. Fatores preditores para ISC foram o índice de estado físico da American Society of Anesthesiologists (ASA) maior ou igual a 3 (OR=6,65, IC95%=1,31-33,69, p=0,02), cirurgia contaminada ou infectada (OR=5,33, IC95%=1,19-23,93, p=0,03), realização de tricotomia (OR=4,60, IC95%=1,03-20,55, p=0,04) e inserção de drenos (OR=3,97, IC95%=1,02-15,46, p=0,04). De modo geral, os hospitais tiveram má performance nos tópicos do checklist . No entanto, somente um desses itens (“manuseio de instrumentos estéreis”) apresentou associação estatística com risco de ISC. Concluímos que incidência de ISC em HPP é surpreendentemente alta, e deve ser objeto de políticas preventivas. Por outro lado, o baixo poder preditivo mostra necessidade de aprimoramento do checklist de contaminação ambiental para que esse reflita adequadamente os riscos infecciosos em sala operatória. / Healthcare associated infections (HAIs) are a worldwide threat, and affect more heavily developing countries. Still, almost all published information concerning incidence and predictors of HAIs come from studies conducted in big-sized and/or teaching hospitals. In Brazil, almost two thirds of hospital have less than 50 beds and are classified as small sized hospitals (SSH). Those hospitals harbor intense surgical and obstetrical activity, and therefore subjects at risk of surgical site infections (SSI). Our study was designed to address the incidence and determinants of SSI in SSH. We followed a cohort of patients submitted to surgeries in three SSH from inner São Paulo State, Brazil. Each surgical procedure was presentially followed, and a checklist of indicators of environmental contamination was applied. Patients were followed for 30 days in order to diagnose SSI. Logistic regression models were used to identify, in separate analysis, (a) predictors of SSI and (b) the statistical association of topics from the checklist to the risk of SSI. The overall incidence of SSI was 8.1%. Predictors identified in multivariable model were: a score in the Amercian Society of Anesthesiologists (ASA) physical status classification of 3 or more (OR=6.65, 95CI%=1.31-33.69, p=0.02), contaminated or dirty wound (OR=5.33, 95%CI=1.19-23.93, p=0.03), perioperatory hair removal (OR=4.60, 95%CI=1.03-20.55, p=0.04) and placement of drains (OR=3.97, 95%CI=1.02-15.46, p=0.04). Overall, hospitals perforemd poorly in the topics of the checklist . However, only one topic (“handling of sterile devices”) was associated to the risk of SSI. In conclusion, the incidente of SSI in SSH is surprisingly high, and must be addressed in preventive policies. On the other hand, the checklist failed in predicting infectious risk, and should therefore be improved.

Orientador: Carlos Magno Castelo Branco Fortaleza / Resumo: As Infecções Relacionadas à Assistência à Saúde (IRAS) são um problema de saúde pública de relevância global, e atingem com mais intensidade os países em desenvolvimento. No entanto, quase todas as informações disponíveis sobre incidência e preditores de IRAS procedem de estudos conduzidos em hospitais de ensino e/ou de grande porte. No Brasil, aproximadamente dois terços dos serviços hospitalares tem menos de 50 leitos, sendo classificados como hospitais de pequeno porte (HPP). Estes albergam intensa atividade cirúrgica e obstétrica, embora voltada a procedimentos de baixa complexidade. São portanto ambientes de risco para infecção do sítio cirúrgico (ISC). Nosso estudo foi delineado para abordar a incidência e os determinantes de ISC em pequenos hospitais. Analisamos uma coorte de pacientes submetidos a procedimentos cirúrgicos em três HPP localizados no interior do Estado de São Paulo. Cada cirurgia foi acompanhada presencialmente, sendo registrados dados dos pacientes e dos processos de trabalho. Ao mesmo tempo, foi aplicado checklist de indicadores de contaminação ambiental em centro cirúrgico. Os sujeitos da pesquisa foram acompanhados por um mês com ligações telefônicas para diagnóstico de infecção do sítio cirúrgico (ISC). Modelos de regressão logística foram aplicados para identificar, separadamente, preditores de ISC e a associação de tópicos do checklist com o risco infeccioso em cirurgias. Foi identificada uma incidência agregada de ISC de 8.1% nos hospitais do es... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Healthcare associated infections (HAIs) are a worldwide threat, and affect more heavily developing countries. Still, almost all published information concerning incidence and predictors of HAIs come from studies conducted in big-sized and/or teaching hospitals. In Brazil, almost two thirds of hospital have less than 50 beds and are classified as small sized hospitals (SSH). Those hospitals harbor intense surgical and obstetrical activity, and therefore subjects at risk of surgical site infections (SSI). Our study was designed to address the incidence and determinants of SSI in SSH. We followed a cohort of patients submitted to surgeries in three SSH from inner São Paulo State, Brazil. Each surgical procedure was presentially followed, and a checklist of indicators of environmental contamination was applied. Patients were followed for 30 days in order to diagnose SSI. Logistic regression models were used to identify, in separate analysis, (a) predictors of SSI and (b) the statistical association of topics from the checklist to the risk of SSI. The overall incidence of SSI was 8.1%. Predictors identified in multivariable model were: a score in the Amercian Society of Anesthesiologists (ASA) physical status classification of 3 or more (OR=6.65, 95CI%=1.31-33.69, p=0.02), contaminated or dirty wound (OR=5.33, 95%CI=1.19-23.93, p=0.03), perioperatory hair removal (OR=4.60, 95%CI=1.03-20.55, p=0.04) and placement of drains (OR=3.97, 95%CI=1.02-15.46, p=0.04). Overall, hospitals per... (Complete abstract click electronic access below) / Mestre