Infection Control & Hospital Epidemiology
Table 1. Effect of 3-Day Average Temperature and Other Parameters on the Risk of Surgical Site Infections—Multivariable Logistic Regression Modela
Factor Temperature (°C)
Time from admission to surgery, d Male gender
Age (by decade) OR (95% CI)
1.07 (1.01–1.14) 1.00 (1.00–1.00) 1.04 (0.85–1.27) 1.09 (1.04–1.13)
Note. OR, odds ratio; CI, confidence interval. aThe model was also adjusted for surgical specialty. bSignificant (P<.05) associations are presented in bold.
53′21″S, 48°29′40″W), and ~7,000 surgical procedures are per- formed there annually. The operating theater is air-conditioned. We collected the average temperatures for the 3 days pre-
ceding each surgical procedure from July 2017 through June 2018. All patients undergoing surgeries during that period were sur- veilled for SSI during admission and postdischarge for 30 days. Multivariable logistic regression models were used to assess the association of temperature and the risk of SSI. Models were adjusted for surgical specialty, time of admission prior to the surgery, and patient demographic data. Analyses were performed using SPSS version 20 software (IBM, Armonk, NY, USA). A total of 6,752 patients underwent surgery in the study per-
iod. The overall SSI rate was 8.2%. Average temperatures for surgical procedures that resulted in an SSI (23.8oC) were slightly but significantly higher than for other procedures (23.6°C; P=.04). The results of the logistic regressions are presented in Table 1. Briefly, temperature was associated with higher risk of SSI in adjusted models. We identified relevant variation in the operating theater temperature during the study period. The 3-day average ranged from 19.5°C to 27.3°C (median, 23.8°C), and daily thermal amplitude reached 8°C. This amplitude is considered high for a tropical climate. Current guidelines recommend that operating-theater tem-
perature must not be too cold, in order to prevent patient hypo- thermia.7,8 Therefore, evidence of SSI seasonality and association with high temperatures seems paradoxical.5,6 It has been hypo- thesized that heat causes surgeon discomfort and may impact negatively on their performance.9 Those apparently conflicting findings imply that further research is required to identify optimal temperatures for the operating theaters. Maintaining such an optimal temperature also poses a special challenge for developing countries, where climate control in hospitals is often not feasible.4 Obviously, difficulties in temperature control in operating
theaters are not the only drivers of SSI in developing countries. A countrywide survey in Brazil found relevant deficits in the overall
Pb
.04 .85 .68
<.001
121
year.1,2 They meet all the requirements to be considered a public health threat. Although low- to middle-income countries face challenges in providing medical and surgical care for their inha- bitants, patient safety should not be a lesser priority in the healthcare agenda. Measures directed at achieving adequate environmental patterns for operating theaters, including tem- perature control, may prevent morbidity, mortality, and addi- tional costs of treating SSI.
structure for infection control, including infection control com- mittees, sterilization services, and microbiology laboratory resources.10 Not surprisingly, high SSI rates occur even in very small hospitals that perform low-complexity surgical procedures.2 SSIs affect thousands of patients in developing countries every
Financial support. M.O.S. and C.M.C.B.F. received grants from the National Council for Scientific and Technological Development (CNPq), Brazil. D.C.L. received a Master of Science grant from the Coordination for the Improve- ment of Higher Level Education Personnel (CAPES), Brasilia, Brazil.
Conflicts of Interest. All authors report no conflicts of interest relevant to this article.
References
1. Allegranzi B, Bagheri Nejad S, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377:228–241.
2. Armede VCB, Abraão LM, Fortaleza CMCB. Surgical site infections in very small hospitals in inner Brazil: unveiling a relevant issue for developing countries. Am J Infect Control 2017;45:935–936.
3. Ayub Khan MN, Verstegen DML, Bhatti ABH, DHJM Dolmans, van Mook WNA. Factors hindering the implementation of surgical site infection control guidelines in the operating rooms of low-income countries: a mixed-method study. Eur J Clin Microbiol Infect Dis 2018. doi: 10.1007/s10096-018-3327-2.
4. Thomas S, Palmer R, Phillipo E, Chipungu G. Reducing bacterial contamination in an orthopedic theater ventilated by natural ventilation, in a developing country. J Infect Dev Ctries 2016;10:518–522.
5. CMCB Fortaleza, Silva MO, Saad Rodrigues F, Cunha AR. Impact of weather on the risk of surgical site infections in a tropical area. Am J Infect Control 2018. doi: 10.1016/j.ajic.2018.08.008.
6. Durkin MJ, Dicks KV, Baker AW, et al. Seasonal variation of common surgical site infections: does season matter? Infect Control Hosp Epidemiol 2015;36:1011–1016.
7. World Health Organization. Global guidelines for the prevention of surgical site infections. Geneva: WHO; 2016.
8. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784–791.
9. Wong SW, Smith R, Crowe P. Optimizing the operating theater environment. ANZ J Surg 2010;80:917–924.
10. Padoveze MC, Fortaleza CM, Kiffer C, et al. Structure for prevention of health care-associated infections in Brazilian hospitals: a countrywide study. Am J Infect Control 2016;44:74–79.
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