The results of this study suggest that preoperative warming can reduce rates of SSI after surgery .
OBJECTIVE To determine whether preoperative warming can reduce the risk of surgical site infection ( SSI ) after surgery .
BACKGROUND Intraoperative hypothermia is a risk factor for the occurrence of  SSI in patients after surgery .
However , the effectiveness of preoperative warming in reducing the incidence of the condition remains unclear .
A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study.
BACKGROUND  Surgical site infections ( SSIs ) are the most frequent health-care-associated infections in developing countries . Specific prevention measures are highly effective , but are often poorly implemented . We aim ed to establish the effect of a multimodal intervention on SSIs in Africa . METHODS We did a before-after cohort study , between July 1 , 2013 , and Dec 31 , 2015 , at five African hospitals . The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures , combined with an adaptive approach aim ed at the improvement of teamwork and the safety climate . The primary outcome was the first occurrence of SSI , and the secondary outcome was death within 30 days post surgery . Data on adherence to SSI prevention measures were prospect ively collected . The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model , after adjustment for key confounders . FINDINGS Four hospitals completed the baseline and follow-up ; three provided suitable ( ie , sufficient number and quality ) data for the sustainability period . 4322 operations were followed up ( 1604 at baseline , 1827 at follow-up , and 891 in the sustainability period )  . SSI cumulative incidence significantly decreased post intervention , from 8·0 % ( 95 % CI 6·8 - 9·5 ; n=129 ) to 3·8 % ( 3·0 - 4·8 ; n=70 ; p<0·0001 ) , and this decrease persisted in the sustainability period ( 3·9 % , 2·8 - 5·4 ; n=35 ) . A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods . The likelihood of SSI during follow-up was significantly lower than pre-intervention ( odds ratio [ OR ] 0·40 , 95 % CI 0·29 - 0·54 ; p<0·0001 ) , but the likelihood of death was not significantly reduced ( 0·72 , 0·42 - 1·24 ; p=0·2360 ) . INTERPRETATION Implementation of our intervention is feasible in African hospitals . Improvement was observed across all perioperative prevention practice s. A significant effect on the overall SSI risk was observed , but with some heterogeneity between sites . Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes . FUNDING US Agency for Healthcare Research and Quality , WHO
The results of this study suggest that preoperative warming can reduce rates of SSI after surgery .
OBJECTIVE To determine whether preoperative warming can reduce the risk of surgical site infection ( SSI ) after surgery .
BACKGROUND Intraoperative hypothermia is a risk factor for the occurrence of  SSI in patients after surgery .
However , the effectiveness of preoperative warming in reducing the incidence of the condition remains unclear .