***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended arm vs 19 % st and ard arm ; P = .004 ) . Multivariate analysis suggested that allocation to the extended arm of the trial conferred a 2.49-fold risk ( 95 % confidence interval , 1.36 - 4.56 ; P = .003 ) independent of other factors traditionally associated with SSI . CONCLUSIONS An evidence -based intervention bundle did not reduce SSIs . The bundling of interventions , even when the constituent interventions have been individually tested , does not have a predictable effect on outcome . Formal testing of bundled approaches should occur prior to implementation A controlled , r and omized study of the efficacy of a plastic wound ring drape ( Opdrape , Triplus ) to prevent contamination and infection in elective colorectal operations is reported . Seventy patients were operated upon with the wound ring drape and 70 patients without .  All patients received preoperative systemic antibiotic prophylaxis .  Abdominal wound infection was observed in seven of 70 ( 10 per cent ) patients with the wound ring drape and six of 70 ( 9 per cent ) without ( N.S. ) . An operative swab for bacteriologic evaluation was obtained from 85 per cent of the wounds . There was no evidence that the drape protected the wound from contamination with intestinal bacterial flora . It was concluded that the wound ring drape prevents neither contamination nor infection PURPOSE : Surgical site infection following colorectal surgery is a frequent and costly problem . Barrier protection at the time of this form of surgery has been used with varying results . The aim of this r and omized study was to examine the efficacy of barrier retractional wound protection in the prevention of surgical site infections in open , elective colorectal surgery . METHODS : One hundred thirty consecutive patients undergoing open elective colorectal resectional surgery were r and omly assigned to have either barrier retractional wound protection or st and ard wound retraction . Patients were then followed up for a minimum of 30 days postoperatively . The primary end point was surgical site infection as defined by the Centers for Disease Control and Prevention . The secondary end point was performance of the wound protector as assessed by operating surgeons . RESULTS : There was a significant reduction in the incidence of incisional surgical site infections when the wound protector was used : 3 of 64 ( 4.7 % ) vs 15 of 66 ( 22.7 % ) ; P = .004 . Most surgical site infections were diagnosed after discharge from the hospital ( 78 % ) , and there was no difference in the rates of reoperation , readmission , or formal wound drainage between the 2 groups . Surgeons found the wound protector to be helpful with retraction during surgery , with 88 % ( 7/8 ) adopting it as part of their st and ard setup . CONCLUSIONS : In this study the use of barrier wound protection in elective open colorectal resectional surgery result ed in a clinical ly significant reduction in incisional surgical site infections .  Barrier wound protection of this nature should be considered routine in this type of surgery A novel design for intervention studies is presented , the so called PROBE study ( Prospect i ve R and omized Open , Blinded End-point ) . This design is compared to the classical double-blind design . Among the advantages of the PROBE design are lower cost and greater similarity to st and ard clinical practice , which should make the results more easily applicable in routine medical care . Since end-points are evaluated by a blinded end-point committee it is obvious that there should be no difference between the two types of trials in this regard A study is reported of the influence of plastic wound protectors on the incidence of wound infection in patients having abdominal operations involving the opening of the alimentary tract or biliary system BACKGROUND We prospect ively investigated whether the wound-protective Alexis ( Applied Medical , Rancho Santa Margarita , CA ) wound retractor was effective in preventing surgical site infection ( SSI ) . METHODS We examined the actual condition of SSI in a 12-month r and omized , controlled trial consisting of 221 patients who had undergone nontraumatic gastrointestinal surgery . The patients were divided into a With Alexis retractor group ( n = 111 ) and a  Without Alexis retractor group ( n = 110 ) . We also analyzed SSI separately on the basis of surgical sites such as gastric surgery or colorectal surgery . RESULTS Overall estimation showed a significant decrease in wound infection ( superficial incisional SSI ) in the With Alexis retractor group . In the analysis based on surgical sites , a significant decrease in wound infection was noted in the With Alexis retractor group , the members of which had undergone colorectal surgery . There was no significant difference between the two groups in the occurrence of organ/space SSI , including anastomotic leak or intraperitoneal abscess . CONCLUSION It was suggested that the use of the Alexis wound retractor would protect surgical wounds from contamination by bacteria and thus prevent infection The preventive effects of a plastic wound drape ( Vi-drape ) on wound contamination and subsequent infection was investigated in 289 appendicectomies r and omized into treatment and control groups . Sample s for quantitative culture of enterobacteria using a simple technique were obtained from the drape , the wound under the drape and from the wounds of patients being operated without the drape .  The drape reduced the number of wound bacteria by an average of 94 % or 1.2 logarithms . The overall rate of postoperative wound infection was 7.6 % in the treatment group and 9.1 % in the control group ( N.S ) . Evidence is presented that the drape might prevent infection in patients with contaminated operations A r and omized controlled trial has been performed to assess the value of plastic wound drapes in the prevention of surgical wound infection .  One hundred and forty‐four patients undergoing abdominal surgery were allocated to one of three groups ; a control group ( A ) in which st and ard cloth towels were applied to the abdominal wound , group B in which an adhesive plastic drape was added and group C in which a plastic ring protector was inserted into the wound Abstract A new plastic device for isolating the edges of incisions into body cavities is described and illustrated . The device , called an incision liner , has certain advantages over conventional technics of covering wound margins . In a group of patients who underwent abdominal operations the use of the incision liner seemed to be effective in minimizing the incidence and severity of wound infections 
    Output:
    
Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery