Lesson Learned: Quality improvement initiatives require multi-

disciplinary input and buy-in. A denitive baseline assessment is

necessary to gauge progress. Having nurses aware of indications led
to greater advocacy for catheter removal.
Presentation Number 4-040
Incidence of Hypothermia under Perioperative
Standard Thermal Management in Patients With
Abdominal Surgery and Its Effect on Surgical Site
Infections
Toshie Tsuchida RN, PhD, Associate Professor, Hyogo University of
Health Sciences; Ms. Kaoru Ichiki, Infection Control Professional,
Head Nurse, Hyogo college of Medicine Hospital; Yoshio Takesue,
Chief Professor, Hyogo College of Medicine; Ms. Yoko Fujimoto,
Head Nurse, Hyogo college of Medicine Hospital
Background/Objectives: Perioperative thermal management has
been routinely performed to prevent hypothermia induced adverse
events including surgical site infections (SSIs). This study aimed to
examine the incidence of hypothermia in abdominal surgeries
under perioperative standard thermal management and its effect
on SSI.
Methods: A retrospective cohort study was conducted involving
patients who underwent liver (BILI-H), pancreatic (BILI-P), esoph-
ageal (ESOP), gastric (GAST), colon (COLN) and rectal (REC) surgery
within the period from January to December 2010. Perioperative
thermal management was performed using a forced-air warming
system in all cases. The following data were collected: the lowest
perioperative rectal temperature (pharyngeal temperature in
patients undergoing colorectal surgery); 5 patient-related charac-
teristics; 5 surgical procedure-related characteristics; and 5 SSI-
related items. Analysis was performed by calculating: 1) the
incidence of each stratied level of hypothermia (mild; 36.0-35.6
degrees C; moderate; 35.5-35.1; and severe; 35.0 or lower) and
odds ratios (OR) for risk factors of hypothermia. 2) risk ratios (RR)
for SSI risk factors, including hypothermia (36.0 degrees C or lower,
35.5 or lower). SSI was diagnosed based on the criteria dened by
the National Healthcare Safety Network.
Results: A total of 632 patients (BILI-H: 81; BILI-P: 46; ESOP: 24;
GAST: 133; COLN: 134; and REC: 196) were studied. The incidence
of each level of hypothermia was as follows: mild 151 patients
(24%); moderate 54 patients (9%); and severe 9 patients (1%). The
RR for each cause of hypothermia with a body temperature of 36.0
degrees C or lower was as follows: thoracolaparotomy 1.84 (95%
Condence Intervals: 1.22-2.76); lithotomy position: 1.28 (1.14-
1.44); males: 1.55(1.20-1.99); a Body Mass Index (BMI) lower than
18.5: 1.42(1.19-1.70); stoma:1.20 (1.03-1.39, P0.01) and anemia:
1.13 (1.01-1.26, p0.038). In multivariate analysis, thoracolapar-
otomy (OR 4.27, 95%CI 2.01-9.07), lithotomy position (1.97, 1.37-
2.83). BMI lower than 18.5 (2.52, 1.67-3.84), males (1.98, 1.35-2.91)
were selected as risk factors for hypothermia with a body
temperature of 36.0 or lower. The perioperative body temperature
was not correlated with the bleeding volume, duration of surgery,
and transfusion volume. The incidence of SSIs was 21% (BILI-H: 16%;
BILI-P: 37%; ESOP: 37%; GAST: 14%: COLN: 15%; and REC: 25%).
Signicant risk factors for SSIs were as follows: contaminated
wounds (1.60, 1.05-2.43); emergency surgery (1.27, 0.98-1.64); and
stoma construction (1.16, 1.05-1.29). Hypothermia (36.0 or lower,
35.5 or lower) was not selected as a signicant risk factor for SSIs
[1.02 (0.94-1.12), and 0.99 (0.87-1.13), respectively].
Conclusions: The incidence of hypothermia in abdominal surgeries
was 34%, and was inuenced by combined thoracotomy, the sex,
surgical position, and body weight; however, the occurrence of
severe hypothermia was rare, and most of patients were included
mild to moderate hypothermia. Hypothermia in such a condition
did not appear to be a risk factor for SSI.
Presentation Number 4-041
Vascular Access Associated Blood Stream Infections
in Patients Undergoing Plasmapheresis Compared
With Those in Patients With Hemodialysis
Kaoru Ichiki, Certied Nurse in Infeion Control - Head Nurse,
Division of Infection Conrol and Prevention Hyogo College of
Medicine; Dr. Toshie Tsuchida, Associate Professor, Hyogo
University of Health Sciences; Yoshio Takesue, Chief Professor,
Hyogo College of Medicine; Dr. Nakajima Kazuhiko, Lecturer,
Hyogo College of Medicine; Mr. Ueda Takashi, pharmacist,
Division of infection control and prevention Hyogo Cllege of
Medicine
Background/Objectives: Vascular access associated blood stream
infections (VABSI) underwent hemopurication have been mainly
studied on hemodialysis (HD). Hemopurication therapy is, also
applied to patients with plasmapheresis (PP). This study aimed to
examine the incidence of VABSI on PPand investigated risk factors
affecting it.
Methods: Patients who underwent PP and HD with vascular
access catheters between January 2007 and September 2011 were
eligible for the study. Blood stream infections were diagnosed
based on the criteria dened by the National Nosocomial Infec-
tions Surveillance (including clinical sepsis) and National Health-
care Safety Network. Analysis was performed by calculating the
incidence of VABSI on HD and PP. The risk factors affecting VABSI
on PP were specied using univariate and multivariate analysis
among 20 factors including nine host factors, six catheter related
factors and 5 other factors (activity on daily living, incontinence,
sanitary conditions, capacity to understand, skin lesion at the
insertion site).
Results: Two hundred seventeen patients with HD and 62 patients
with PP were observed. Mean number of hemopurication therapy
were 5.64.2 on HD and 4.82.4 on PP. Primary diseases under-
went PP were as follows: Multiple sclerosis 32 patients, Myasthenia
gravis 9 patients, Chronic inammatory demyelinating poly-
radiculoneuropathy 8 patients, Lambert-Eaton myasthenic sym-
drome and bullous pemphigoid 4 patients. The incidence of VABSI
was 8.8% (6.29/1,000 device-day) on HD, 14.5% (9.2/1,000 device-
day) on PP (P0.18 and P0.10). The Odds ratio of PP for cause of
VABSI was 0.82 (95%CI; 0.58-1.15; P0.24). PP was not an inde-
pendent risk factor of VABSI in patients with hemopurication.
Variables that achieved statistical signicance in the univariate
analysis for cause of VABSI in patients with PP were follows:
emergent insertion of vascular access, steroid pulse therapy and
patients with poor hygiene. In multivariate analysis, emergency
insertion was identied as the only independent risk factor of
VABSI on PP.
Conclusions: There was no signicant difference in the incidence
of VABSI in patients with HD and PP. Further study is required to
conclude the difference among the patients with hemopurication
therapy. Emergency insertion was the risk factor affecting VABSI
on PP.
Poster Abstracts / American Journal of Infection Control 40 (2012) e31-e176 e55
APIC 39th Annual Educational Conference & International Meeting j San Antonio, TX j June 4-6, 2012