Efficacy of Surgical Preparation Solutions in Lumbar Spine Surgery

Savage, Jason W.; Weatherford, Brian M.; Sugrue, Patrick A.; Nolden, Mark; Liu, John C.; Song, John K.; Haak, Michael

doi:10.2106/jbjs.k.00471

Cited by 78 publications

(59 citation statements)

References 14 publications

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“…This result is consistent with previous observations in the shoulder 10,40,45,46 and in the spine 41 . Propionibacterium usually did not grow on culture of dermal specimens from female subjects whereas dermal cultures were commonly positive for male patients.…”

Section: Discussionsupporting

confidence: 94%

“…It is commonly assumed that the patient's epidermal skin surface is the source of the Propionibacterium grown on culture of specimens from infected orthopaedic implant sites. Unfortunately, presurgical skin surface preparations do not completely eliminate Propionibacterium [39][40][41][42] , perhaps because the organism is sheltered in dermal sebaceous glands, each of which may harbor as many as 10 5 Propionibacterium organisms per follicle 43 . Surgical incisions transect the sebaceous glands, after which these organisms may Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Origin of Propionibacterium in Surgical Wounds and Evidence-Based Approach for Culturing Propionibacterium from Surgical Sites

Matsen

Butler-Wu

Carofino³

et al. 2013

The Journal of Bone & Joint Surgery

146

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Origin of Propionibacterium in Surgical Wounds and Evidence-Based Approach for Culturing Propionibacterium from Surgical Sites

Matsen

Butler-Wu

Carofino³

et al. 2013

The Journal of Bone & Joint Surgery

146

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show abstract

“…Of the 34 articles that underwent full-text review, 12 [22][23][24][25][26][27][28][29][30][31][32][33] met eligibility criteria for inclusion in the meta-analysis and 22 were excluded. The most common reasons for exclusion of the 22 studies were: criteria for the diagnosis of SSI not reported and/or CDC/NNIS criteria not applied [34][35][36][37][38][39][40][41][42][43][44][45][46][47], non-scalar definitions of obesity used [47][48][49], risk estimates of the association between obesity/BMI and SSI not reported or raw data not provided to calculate risks [44,47,[50][51][52][53], and analyses restricted to deep wound infections [54,55].…”

Section: Literature Search and Systematic Review Resultsmentioning

confidence: 99%

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

2013

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Purpose Inconsistent results have been reported in the literature on the association between obesity, expressed as increased body mass index (BMI), and risk for surgical site infection (SSI) following spine surgery. The objective of this study was to review and quantify the association between increased BMI and risk of spinal SSI in adults. Methods We performed a comprehensive search for relevant studies using PubMed, Embase, and references of published manuscripts. Study-specific risk measures were transformed into slope estimates and combined using the random effects meta-analysis model to establish the risk of SSI associated with every 5-unit increase in BMI. Results Thirty-four articles underwent full-text review. Variations were noted among these studies in relation to SSI diagnosis criteria and BMI cut-off levels used to define obesity. Data from 12 retrospective studies were included in the analyses. Results showed that BMI was significantly positively associated with the risk of spinal SSI. Unadjusted risk estimates demonstrated that a 5-unit increase in BMI was associated with 13 % increased risk of SSI [Crude odds ratio (OR): 1.13; 95 % CI: 1.07-1.19, p\ 0.0001]. Pooling of risk estimates adjusted for diabetes and other confounders resulted in a 21 % increase in risk of spinal SSI for every 5-unit increase in BMI (adjusted OR: 1.21; 95 % CI 1.13-1.29, p \ 0.0001). ConclusionHigher BMI is associated with the increased risk of SSI following spine surgery. Prospective studies are needed to confirm this association and to determine whether other measures of fat distribution are better predictors of risk of SSI.

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“…12,56,57 Savage et al 12 reported 100 consecutive lumbar spinal surgery patients, finding no differences between ChloraPrep (2% CHG and 70% isopropyl alcohol; Enturia, El Paso, Texas) and DuraPrep (0.7% available iodine and 74% isopropyl alcohol; 3M Healthcare, St. Paul, Minnesota) in the rate of positive culture results after skin preparation.…”

Section: Skin Antisepsismentioning

confidence: 99%

“…Although the most common skin bacteria are coagulasenegative Staphylococcus, Propionibacterium acnes (P. acnes), and Corynebacterium, 12 the most frequent pathogen that causes SSI is Staphylococcus aureus, 13 which accounts for approximately 50% of all SSIs.…”

mentioning

confidence: 99%

Prevention of Surgical Site Infection in Spine Surgery

et al. 2017

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BACKGROUND: Spine surgery is complicated by an incidence of 1% to 9% of surgical site infection (SSI). The most common organisms are gram-positive bacteria and are endogenous, that is are brought to the hospital by the patient. Efforts to improve safety have been focused on reducing SSI using a bundle approach. The bundle approach applies many quality improvement efforts and has been shown to reduce SSI in other surgical procedures. OBJECTIVE: To provide a narrative review of practical solutions to reduce SSI in spine surgery. METHODS: Literature review and synthesis to identify methods that can be used to prevent SSI. RESULTS: SSI prevention starts with proper patient selection and optimization of medical conditions, particularly reducing smoking and glycemic control. Screening for staphylococcus organisms and subsequent decolonization is a promising method to reduce endogenous bacterial burden. Preoperative warming of patients and timely administration of antibiotics are critical to prevent SSI. Skin preparation using chlorhexidine and alcohol solutions are recommended. Meticulous surgical technique and maintenance of sterile techniques should always be performed. Postoperatively, traditional methods of tissue oxygenation and glycemic control remain essential. Newer wound care methods such as silver impregnation dressing and wound-assisted vacuum dressing are encouraging but need further investigation. CONCLUSION: Significant reduction of SSIs is possible, but requires a systems approach involving all stakeholders. There are many simple and low-cost components that can be adjusted to reduce SSIs. Systematic efforts including understanding of pathophysiology, prevention strategies, and system-wide quality improvement programs demonstrate significant reduction of SSI.

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Efficacy of Surgical Preparation Solutions in Lumbar Spine Surgery

Abstract: ChloraPrep and DuraPrep are equally effective skin-preparation solutions for eradication of common bacterial pathogens on the skin overlying the lumbar spine.

Cited by 78 publications

References 14 publications

Origin of Propionibacterium in Surgical Wounds and Evidence-Based Approach for Culturing Propionibacterium from Surgical Sites

Origin of Propionibacterium in Surgical Wounds and Evidence-Based Approach for Culturing Propionibacterium from Surgical Sites

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

Prevention of Surgical Site Infection in Spine Surgery

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