***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 
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    Input: BACKGROUND Kaiser Sunnyside Medical Center has participated in the American College of Surgeons National Surgical Quality Improvement Program ( NSQIP ) since January 2006 . Data on general and colorectal surgical site infections ( SSIs ) demonstrated a need for improvement in SSI rates . OBJECTIVE To evaluate application of a " care bundle " for patients undergoing colorectal operations , with the goal of reducing overall SSI rates . METHODS We prospect ively implemented multiple interventions , with retrospective analysis of data using the NSQIP data base . The overall , superficial , deep , and organ/space SSI rates were compared before and after implementation of this colorectal care bundle . RESULTS Between January 2006 and December 2009 , there were 430 colorectal cases in our NSQIP report with 91 infections , an overall rate of 21.16 % . Between January 2010 , when the colorectal care bundle was implemented , and June 2011 , there were 195 cases and 13 infections , a 6.67 % overall rate . The absolute decrease of 14.49 % is significant ( p < 0.0001 ) . The rate of superficial SSI decreased from 15.12 % to 3.59 % ( p < 0.0001 ) . The rates for deep and organ/space SSI also showed a decrease ; however , this was not statistically significant . The NSQIP observed-to-expected ratio for colorectal SSI decreased from a range of 1.27 to 1.83 before implementation to 0.54 after implementation ( fiscal year 2010 ) . CONCLUSIONS Our institution was a NSQIP high outlier in general surgery SSIs and had a high proportion of these cases represented in colorectal cases . By instituting a care bundle composed of core and adjunct strategies , we significantly decreased our rate of colorectal SSIs Background Wound-edge protection devices ( WEPDs ) have been used in surgery for more than 40 years to reduce surgical site infection ( SSI ) . No economic evaluation of WEPDs against any comparator has ever been conducted . The aim of the paper was to assess whether WEPDs are cost-effective in reducing SSI compared to st and ard care alone in the United Kingdom . Methods and Findings An economic evaluation was conducted alongside the ROSSINI trial . The study perspective was that of the UK National Health Service and the time horizon was 30 days post-operatively . The study was conducted in 21 UK hospitals . 760 patients undergoing laparotomy were r and omised to either WEPD or st and ard care and 735 were included in the primary analysis . The main economic outcome was cost-effectiveness based on incremental cost ( £ ) per quality adjusted life year ( QALY ) gained . Patients in the WEPD arm accessed health care worth £ 5,420 on average and gained 0.02131 QALYs , compared to £ 5,130 and 0.02133 QALYs gained in the st and ard care arm . The WEPD strategy was more costly and equally effective compared to st and ard care , but there was significant uncertainty around incremental costs and QALYs . The findings were robust to a range of sensitivity analyses . Conclusions There is no evidence to suggest that WEPDs can be considered a cost effective device to reduce SSI . Their continued use is a waste of limited health care re sources Objective To determine the clinical effectiveness of wound edge protection devices in reducing surgical site infection  after abdominal surgery . Design Multicentre observer blinded r and omised controlled trial . Participants Patients undergoing laparotomy at 21 UK hospitals . Interventions St and ard care or the use of a wound edge protection device during surgery . Main outcome measures Surgical site infection within 30 days of surgery , assessed by blinded clinicians at seven and 30 days and by patient ’s self report for the intervening period . Secondary outcomes included quality of life , duration of stay in hospital , and the effect of characteristics of the patient and operation on the efficacy of the device . Results 760 patients were enrolled with 382 patients assigned to the device group and 378 to the control group . Six patients in the device group and five in the control group did not undergo laparotomy . Fourteen patients , seven in each group , were lost to follow-up . A total of 184 patients experienced surgical site infection within 30 days of surgery , 91/369 ( 24.7 % ) in the device group and 93/366 ( 25.4 % ) in the control group ( odds ratio 0.97 , 95 % confidence interval 0.69 to 1.36 ; P=0.85 ) . This lack of benefit was consistent across wound assessment s performed by clinicians and those reported by patients and across all secondary outcomes . In the secondary analyses no subgroup could be identified in which there was evidence of clinical benefit associated with use of the device . Conclusions Wound edge protection devices do not reduce the rate of surgical site infection in patients undergoing laparotomy , and therefore their routine use for this role can not be recommended . Trial registration Current Controlled Trials IS RCT N A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials Aim Surgical site infection ( SSI ) remains a common postoperative morbidity , particularly in colorectal resections , and poses a significant financial burden to the healthcare system . The omission of mechanical bowel preparation , as is performed in enhanced recovery after surgery programmes , appears to further increase the incidence . Various wound protection methods have been devised to reduce the incidence of SSIs . However , there are few r and omized controlled trials assessing their efficacy . The aim of this study is to investigate whether ALEXIS wound retractors with reinforced O‐rings are superior to conventional wound protection methods in preventing SSIs in colorectal resections Introduction Surgical site infections ( SSIs ) are frequent complications in colorectal surgery and may lead to burst abdomen , incisional hernia , and increased perioperative costs . Plastic wound ring drapes ( RD ) were introduced some decades ago to protect the abdominal wound from bacteria and reduce SSIs . There have been no controlled trials examining the benefit of RD in laparoscopic colorectal surgery . The Reduction of wound infections in laparoscopic assisted colorectal resections by plastic wound ring drapes ( REDWIL ) trial was thus design ed to assess their effectiveness in preventing SSIs after elective laparoscopic colorectal resections . Material s/ methods REDWIL is a r and omized controlled monocenter trial with two parallel groups ( experimental group with RD and control group without RD ) . Patients undergoing elective laparoscopic colorectal resection were included . The primary endpoint was SSIs . Secondary outcomes were colonization of the abdominal wall with bacteria , reoperations/readmissions , early/late postoperative complications , and cost of hospital stay . The duration of follow-up was 6 months . Results Between January 2008 and October 2010 , 109 patients were r and omly assigned to the experimental or control group ( with or without RD ) . Forty-six patients in the RD group and 47 patients in the control group completed follow-up .  SSIs developed in ten patients with RD ( 21.7 % ) and six patients without RD ( 12.8 % ) ( p = 0.28 ) . An intraoperative swab taken from the abdominal wall was positive in 66.7 % of patients with RD and 57.5 % without RD ( p = 0.46 ) . The number of species cultured within one swab was significantly higher in those without RD ( p = 0.03 ) . The median total inpatient costs including emergency readmissions were 3,402 ± 4,038 € in the RD group and 3,563 ± 1,735 € in the control group ( p = 0.869 ) . Conclusions RD do not reduce the rate of SSIs in laparoscopic colorectal surgery . The inpatient costs are similar with and without RD 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 Introduction Surgical site infections ( SSIs ) remain a major problem in colorectal surgery . Method In this prospect i ve , r and omised study , we compared two kinds of wound protection , namely , “ plastic ring drape ” versus “ st and ard cloth towels ” .  One hundred one patients were r and omised to the control group ( wet cloth towels ) and 98 to the study cohort ( ring drape ) .  SSIs were classified according to Centers for Disease Control and Prevention recommendations . Discussion In the control group , 30 patients had an SSI , whereas 20 did so in the study group . This difference was not significant ( p = 0.131 ) . Conclusion Plastic ring drape for wound protection does not guard against SSIs in colorectal surgery Surgical site infections ( SSIs ) after cesarean section appear to be more common than generally believed . We prospect ively evaluated 231 consecutive pregnant women who underwent elective or emergency cesarean section  , and were assigned to have either the Alexis wound retractor ( study group ) or a conventional Doyen retractor ( control group ) during the operation . There was no evidence of SSI , defined as wound dehiscence , pain or tenderness in the lower abdomen , localized swelling , redness , heat or purulent discharge from the wound in any woman in the study group . Moreover , no endometritis occurred in this patient collective . There were three SSI in the control group , but no endometritis . Our preliminary data show excellent protection of wound infections with an additive protective effect to that given by antibiotic cover . After a short learning curve , the h and ling of the Alexis device became easier and the median insertion time was 18 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 
    Output:
    
WEPD seems to be an effective intervention to reduce the risk of post-operative SSI in patients undergoing abdominal surgery