A Multidisciplinary Infection Control Bundle to Reduce the Number of Spinal Cord Stimulator Infections

Yusuf, Erlangga; Bamps, Sven; Thüer, Bénédicte; Mattheussen, Jan; Ursi, J. P.; Biondo, Elke Del; Smedt, K. De; Paesschen, Raf Van; Berghmans, D.; Hofkens, Kaat; Schaeren, J. Van; Havenbergh, Tony Van; Herendael, Bruno Van

doi:10.1111/ner.12555

Cited by 22 publications

(13 citation statements)

References 13 publications

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“…SSI reduction “bundling” recently has gained interest as a means of managing the complicated, multifactorial nature of SSIs [7–10]; however, results have been mixed across a range of subspecialties [11, 12]. Colorectal surgery, consistently associated with the highest SSI rates, has been particularly notable for equivocal results on SSI reduction bundling in various studies using a mixture of interventions [7, 9, 13–21].…”

Section: Introductionmentioning

confidence: 99%

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Schiavone

Moukarzel

Leong

et al. 2017

Gynecologic Oncology

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Objective Surgical site infections (SSIs) can lead to substantial morbidity, prolonged hospitalization, increased costs, and death in patients undergoing colorectal procedures. We sought to investigate the effect of using an SSI reduction bundle on the rate of SSIs in gynecologic cancer patients undergoing colon surgery. Methods We identified all gynecologic cancer patients who underwent colon resection at our institution from 2014–2016, during which time a service-wide SSI reduction bundle was introduced. The intervention included preoperative oral antibiotics with optional mechanical bowel preparation, skin preparation with antibacterial solution, and the use of a separate surgical closing tray. SSI rates were assessed within 30 days post-surgery. Results Of 233 identified patients, 115 had undergone colon surgery prior to (PRE) and 118 after (POST) the implementation of the intervention. A low anterior resection was the most common colon surgery in both cohorts. The incidence of SSI within 30 days of surgery was 43/115 (37%) in the PRE and 14/118 (12%) in the POST cohorts (p≤0.001). Wound dehiscence was noted in 30/115 (26%) and 2/118 (2%) patients, respectively (p≤0.001). In patients whose operation took longer than 360 minutes, 30-day SSI rates were 37% (28/76) and 12% (8/67), respectively (p≤0.001). In patients with an estimated blood loss >500 cc, SSI rates were 44% (27/62) and 15% (10/67), respectively (p≤0.001). Conclusions The implementation of an SSI reduction bundle was associated with a significant reduction in 30-day SSIs in these patients. The intervention remained effective in patients undergoing longer operations and in those with increased blood loss.

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Section: Introductionmentioning

confidence: 99%

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Schiavone

Moukarzel

Leong

et al. 2017

Gynecologic Oncology

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“…Awareness of this might have led to changes in infection control practices at study centers, and these changes (as opposed to the elimination of prolonged trials) might have played a role in the observed improvement. Indeed, improvement in SCS infection rates has been reported in nonrandomized case series after additional infection control measures were implemented . Perhaps this also reflects regression to the mean.…”

Section: Discussionmentioning

confidence: 87%

Postoperative Infections Associated With Prolonged Spinal Cord Stimulation Trial Duration (PROMISE RCT)

North

Desai

Vangeneugden

et al. 2020

Neuromodulation: Technology at the Neural Interface

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; on behalf of the PROMISE Study Group Introduction: In the PROMISE study, a multinational randomized controlled trial (RCT) of the effectiveness of spinal cord stimulation (SCS) with multicolumn surgical leads as a treatment of low back pain, clinicians followed their usual practice. An early, unplanned safety analysis revealed that the infection rate in Belgium (5/23), where trial duration was a median 21.5 days, was significantly higher than the 1/64 rate observed in the other study countries (median 5.8 days, p < 0.01). This report reviews infections observed in the PROMISE study after study completion. Materials and Methods: For all infections related to SCS, we used descriptive statistics and tests of independent variables to analyze potentially contributing factors (age, sex, coexisting medical conditions, tobacco use, lead type, and trial duration) between subjects with infections versus those without. Cumulative incidence curves were created using the Kaplan-Meier method and compared between the two strata using a log-rank test. Results: Among nine (5.2%) infections in 174 subjects trialed, the only significant contributing factor to infection was trial duration: median 21 days (range 3-56) for those with infection vs. six days (1-41) for those without (p = 0.001; Wilcoxon rank-sum test). The cumulative incidence of infection for subjects trialed >10 days was 24.1% vs. 1.4% for subjects trialed ≤10 days (p < 0.001). After the protocol was amended to limit trial duration to 10 days, 14 infection-free trials were performed in Belgium. Conclusions: Although not part of the preplanned analysis, our observation supports the hypothesis of a cause-effect relationship between trial duration and the risk of infection and the conclusion that prolonged SCS trials should be avoided.

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“…This estimate coupled with the recent low level of compliance demonstrated with evidence‐based practices for the field of neuromodulation indicate the need for quality improvement . The introduction of quality improvement project recommendations for the reduction of SCS SSI have been shown to significantly improve outcomes . Moreover, infection‐related quality improvement projects have been found to result in overall cost savings due to infection avoidance in other disease states .…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Stimulation Infection Rate and Incremental Annual Expenditures: Results From a United States Payer Database

Provenzano¹,

Falowski²,

Xia

et al. 2019

Neuromodulation: Technology at the Neural Interface

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A Multidisciplinary Infection Control Bundle to Reduce the Number of Spinal Cord Stimulator Infections

Cited by 22 publications

References 13 publications

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Postoperative Infections Associated With Prolonged Spinal Cord Stimulation Trial Duration (PROMISE RCT)

Spinal Cord Stimulation Infection Rate and Incremental Annual Expenditures: Results From a United States Payer Database

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