Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: A randomised controlled trial. Lancet. 2001;358(9285):876-880.

This is a report of a randomized controlled trial assessing the efficacy of local or systemic warming of patients prior to clean operations in reducing the incidence of surgical site infections. This study found an overall infection rate of eight percent; the combined warming group’s infection rate was five percent while the control group’s rate was 14 percent.  

Latham R, Lancaster AD, Covington JF, Pirolo JS, Thomas CS. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infection Control and Hospital Epidemiology. 2001;22(10):607-612.

The objective of this prospective study was to assess the relative importance of chronic glycemic control, perioperative glucose management, and previously undiagnosed diabetes in the development of postoperative infection. The study found that the rate of surgical site infections correlated with the degree of hyperglycemia during the postoperative period (O/R 2.54 for glucose 200-249; 2.97 for glucose 250-300 and 3.32 for glucose levels >300).

Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. New England Journal of Medicine. 1996;334(19):1209-1216.

This paper describes a randomized, double-blind study to test the hypothesis that mild core hypothermia increases the incidence of surgical wound infection and lengthens hospital stay in patients undergoing colorectal surgery.

Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clinic Proceedings. 2004;79(8):992-1000.

A glucose management protocol was adopted by a university-affiliated community teaching hospital in a 14-bed medical-surgical intensive care unit. It involved using intensive monitoring and treatment to maintain plasma glucose levels lower than 140mg/dL.

Ko W, Lazenby WD, Zelano JA, Isom OW, Krieger KH. Effects of shaving methods and intraoperative irrigation on suppurative mediastinitis after bypass operations. The Annals of Thoracic Surgery. 1992;53(2):301-305.

This paper describes a prospective randomized trial examining two variables — hair removal by shaving (razor) vs. clipping, and use of povidone-iodine vs. saline for intraoperative irrigation — to determine the effects of these variables on the occurrence of postoperative suppurative mediastinitis.

Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: Attributable mortality, excess length of hospitalization, and extra costs. Infection Control and Hospital Epidemiology. 1999;20(11):725-730.

This paper describes a prospective, case-controlled study of 22,742 patients undergoing inpatient surgical procedures between June 1, 1991, and July 31, 1995.  The objective of the study was to examine the mortality, need for intensive care admission, need for readmission to the hospital within 30 days of discharge, length of stay, and cost attributable to surgical site infection.

Khuri SF, Daley J, Henderson WG. The comparative assessment and improvement of quality of surgical care in the Department of Veterans Affairs. Archives of Surgery. 2002;137(1):20-27.

The VA National Surgical Quality Improvement Program (NSQIP) is the focus of this article, in which the authors describe the evolution, methods, and future plans of the NSQIP.  The program uses 52 preoperative data variables, 15 intraoperative variables, and postoperative laboratory variables, as well as morbidity and mortality data to comparatively assess the quality of surgical care in VA hospitals.

DiPiro JT, Cheung RP, Bowden TA Jr, Mansberger JA. Single dose systemic antibiotic prophylaxis of surgical wound infections. American Journal of Surgery. 1986;152(5):552-559.

This paper examines over 40 published studies in which single doses of parenteral antimicrobials were given for the purpose of preventing surgical infection.  The studies involve the comparison of single-dose antibiotic versus multiple-dose, single-dose versus placebo, single-dose of one drug versus multiple doses of another drug, or comparisons of single-dose regimens of various antibiotics.

Dellinger EP. Preventing surgical-site infections: The importance of timing and glucose control. Infection Control and Hospital Epidemiology. 2001;22(10):604-606.

This editorial examines the impact of strategies developed over the years to prevent surgical wound infections.  Dr. Dellinger begins with the recognition of the role of bacteria and the development of aseptic technique.  He then discusses the introduction of prophylactic antibiotics in the 1960s and, more recently, changes in practice regarding hair removal, temperature control, and tissue oxygen levels.

Dellinger EP, Gross PA, Barrett TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Released in 1994 (reviewed 1998). Infection Control and Hospital Epidemiology. Mar 1994;18(3):422-427.

This is a standard developed by The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society (IDSA).  The standard is endorsed by IDSA, the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA).  The intended outcome of this standard is for “more uniform and reliable administration of prophylactic antibiotics in those circumstances where their value has been demonstrated or their use has been judged by the local practicing medical community to be desirable.”