Date of this Version


Document Type

DNP Project



Background: Evidence has shown that a high percentage of oxygen given during surgery has been linked to an increase in poor health outcomes. Yet, high dose oxygen is still given intraoperatively to lessen patient surgical site infection rates. During this educational session, an educational module and questionnaire will be provided to anesthesia providers pre- and post-teaching to assess and expand knowledge on oxygen and its relation to SSI.

Objectives: A systematic review that assesses the best present randomized controlled trials (RCTs) regarding low dose fio2 (80%). Information and results from the systematic review will be presented to anesthesia providers in an education module.

Data Sources: Investigators used CINAHL, MedLine, and Science Direct databases to answer the PICO (i.e., population, intervention, comparison, outcome) question: In current anesthesia providers (P), how does an educational session on the role of high vs. low fio2 in the prevention of surgical site infection (I) improve provider's knowledge that both concentrations of oxygen can provide the same similar rates in SSI prevention while avoiding the poorer health outcomes associated with an elevated fio2, as compared to before the educational session (C) as evident by an increase in examination score in the post-evaluation survey (O)?

Methodology: 6 RCTs and meta-analysis of RCTs were included in this systematic review and incorporated into anesthesia providers' educational module. Inclusion criteria included: Male or female, age ≥ 18, English language, RCTs, published after 2012, and SSI defined by the CDC. The 6 RCTs had a combined sample size of 7641 patients. Four RCTs analyzed patients undergoing general anesthesia, and two RCTs analyzed patients going through cesarean section. All studies found that 80% fio2. The systematic review results were presented in an education module containing a pre-and post-test with a voiced-over PowerPoint to a group of anesthesia providers.

Results: Statistical analysis using SPSS revealed a statistically significant knowledge increase from the pre- to post-test. Furthermore, there was an increased likelihood of recommending low dose fio2 for SSI prevention.

Conclusions: Data shows the use of low dose fio2 (80%). CRNAs benefit from an educational module presenting the most current evidence-based information regarding intraoperative oxygen levels and its relation to SSI prevention. This knowledge increases also led to providers being more likely to recommend the use of low-dose fio2 intraoperatively for SSI prevention.

Keywords: Surgical site infection, SSI, fio2, oxygen, intraoperative, infection, surgery, anesthesia.