Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery

Rubeli, Samuel L; D’Alonzo, Donato; Mueller, Beate; Bartlomé, Nicole; Fankhauser, Hans; Bucheli, Evelin; Conen, Anna; Fandiño, Javier; Fux, Christoph A

doi:10.3171/2019.5.focus19272

Cited by 20 publications

(12 citation statements)

References 44 publications

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“…According to studies in Europe, the most common infection types are pneumonia, surgical-site infections, and gastrointestinal infections [7]. Other studies showed that pneumonia, bloodstream infection and central venous infection were the most common types [9]. The ndings of this study were similar to the other studies for the types of infection, including pneumonia (65.3%), primary bloodstream infection (13.7%), central nervous system infections (8.4%).…”

Section: Infection Typessupporting

confidence: 81%

Risk Factors and Incidence for HAI in Elderly Patients Undergoing Neurosurgery in a Single Center

Liu

Zhang

et al. 2021

Preprint

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Background: Health care-associated-infection (HAI) is an important issue in neurosurgery department. With the aging population, we are receiving an increasing number of elderly patients who have a higher risks of HAI. AIM: We want to better understand risk factors of HAI and prevent HAI in elderly patients who accept neurosurgeries.Methods: This was a case-control study. We took review of the medical records of patients aged 60 and older who underwent neurosurgical operations from 1 January to 31 December 2016 in a single centre. Patients with infection and intubation before admission were excluded. Risk factors and outcomes were analysed, including age, sex, activities of daily living (ADL) score, smoking history, emergency admission status, ICU stay, ventilator use, ventilation time, diabetes, coronary heart disease, immune system disease, consciousness at admission, albumin decrease, blood sugar, unplanned second operation, indwelling venous catheter, external ventricular drainage (EVD), discharge ADL, length of stay (LOS), and medical costs.Results: A total of 1757 geriatric patients over 60 years underwent neurosurgical procedure were enrolled. Their age ranged from 60 to 93 years, with an average of 67.56 ± 6.16 years, including 1083 males(61.6%)and 674 females(38.4%).Among 1757 patients in 14703 hospital days, 95 cases of infection were diagnosed with HAIs in 78 patients, The HAI rate was 4.4% (78/1757) and HAI case rate was 5.4%(95/1757),incidence of HAI in neurosurgical geriatric patients was 6.5‰. Of these 95 infections, the most common types were pneumonia (65.3%), followed by primary bloodstream infection (13.7%), central nervous system infection (8.4%), urinary tract infection (6.3%), and wound infection (6.3%). Multivariable logistic regression showed that the independent risk factors for HAI in elderly patients were ICU stay, mechanical ventilation, plasma albumin below 35g/L, unplanned reoperation, and venous catheterization.Conclusions: To prevent HAI, we should improve the ICU standards, decrease ventilation time, improve the nutrition supply, and dynamically evaluate the necessity of deep venous catheters and remove them as early as possible. Such measures could not only help reduce HAI and shorten hospital stays for elderly patients, but also decrease medical insurance cost for the government.

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Section: Infection Typessupporting

confidence: 81%

Risk Factors and Incidence for HAI in Elderly Patients Undergoing Neurosurgery in a Single Center

Liu

Zhang

et al. 2021

Preprint

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“…In cases of skull trauma, chronic bone flap infection or bone flap resorption, where the bone flap is not reusable owing to multiple fragments, mature biofilm or aseptic bone necrosis, a synthetic cranioplasty is used (polyether ether ketone [PEEK], poly methyl methacrylate [PMMA] or titanium) [34,35]. Risk factors for infection are diabetes, presence of an EVD, CSF leakage, intracerebral haematoma and tumour surgery [36][37][38][39][40][41]. Craniotomy-and cranioplasty-associated infections usually manifest early after surgery (within the first month) and most commonly are caused by pathogens of the skin flora, namely staphylococci [36][37][38][39][42][43][44].…”

Section: Specific Infections Craniotomy-and Cranioplasty-associated Infectionsmentioning

confidence: 99%

Management of neurosurgical implant-associated infections

et al. 2020

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With the technical developments in neurosurgery, increasing numbers of neurosurgical implants are used in an increasingly aged population of patients with several comorbidities. Consequently, the number of neurosurgical implant-associated infections is continuously raising, resulting in significant morbidity and mortality, including disfiguring skull deformities and lack of brain protection. In this article we review infections associated with craniotomy, cranioplasty, neurostimulators, internal cerebrospinal fluid shunts, and external ventricular and lumbar cerebrospinal fluid drainages.

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“…The incidence of CNS infection was also high in our patients. removing unnecessary drainage/ monitoring intracranial tubes [37], antibiotic prophylaxis might be helpful for the prevention of meningitis and surgical site infection after craniotomy [38,39].…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors and Outcomes of Sepsis in Post-Craniotomy Critical Ill Patients

Zhou

Luo

Chen

et al. 2021

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Background: Data about the epidemiology of sepsis in post-craniotomy critical ill patients are scarce. This study aims to assess the incidence, risk factors, and outcomes of sepsis in this population.Methods: We conducted a prospective cohort study between January 1, 2017, and December 31, 2018, in the intensive care unit (ICU) of Beijing Tiantan Hospital. Patients admitted to ICU after intracranial operations and meeting the inclusion criteria were screened daily for the presence of infection and sepsis. We also collected demographics, primary diagnosis, chronic comorbidities, information about surgery, infection, and patients’ outcomes. Results: Of the 900 included patients, 509 (56.6%) were with infection, and 300 developed sepsis. The cumulative incidence of sepsis was 33.3% [95% CI, 30.2%-36.4%]. Male sex, older in age, supratentorial surgery, the sellar region tumors, postoperative hydrocephalus, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, higher Sequential Organ Failure Assessment (SOFA) score, and lower Glasgow Coma Scale (GCS) were independent risk factors of sepsis. Sepsis was associated with a higher hospital mortality rate (13.7% vs. 8.3%, p =0.012), lower Glasgow Outcome Scale (GOS) at discharge (3 vs. 4, p<0.001), longer ICU length of stay (LOS) (14 vs. 4 days, p<0.001), longer hospital LOS (31 vs. 19 days, p<0.001), and higher total medical costs (RMB 138,394 vs 75,918 Yuan, p<0.001). Conclusions: Sepsis is a frequent complication in post-craniotomy critical ill patients, and is associated with increased hospital mortality rate, increased hospital costs, prolonged ICU LOS, and hospital LOS.Trial registration: Clinicaltrials.gov number: NCT03803813

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Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery

Cited by 20 publications

References 44 publications

Risk Factors and Incidence for HAI in Elderly Patients Undergoing Neurosurgery in a Single Center

Risk Factors and Incidence for HAI in Elderly Patients Undergoing Neurosurgery in a Single Center

Management of neurosurgical implant-associated infections

Incidence, Risk Factors and Outcomes of Sepsis in Post-Craniotomy Critical Ill Patients

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