Reduction of Surgical Site Infections After Cranioplasty With Perioperative Bundle

Liu, Huiquan; Dong, Xinlong; Yin, Yue; Chen, Zixiang; Zhang, Jianning

doi:10.1097/scs.0000000000003650

Cited by 15 publications

(15 citation statements)

References 23 publications

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“…23 Similarly, Liu et al improved postcranioplasty infection rates from 10.5% to 1.8% using an IPB as well as active SSI monitoring. 26 Both studies had remarkably high preintervention SSI rates and a low number of included patients (57 and 199, respectively), as compared to the 520 patients included in our study. Conversely, an IPB addressing perioperative glucose and body temperature control had no effect on SSI.…”

Section: Discussionmentioning

confidence: 59%

“…IPBs have reduced SSI rates for a broad range of interventions 34 including colon, 40,45 cardiac, and orthopedic surgery, 27 but also cranial neurosurgery. 17,23,26 In all of the above-mentioned guidelines, standardized surveillance with immediate personal feedback to surgeons is considered key, as this measure by itself reduces SSI. 12 In cranial neurosurgery, male sex, age greater than 60 years, smoking, longer preoperative stay, an operative duration longer than 3 hours, emergency or repetitive surgery, contaminated surgery, the use of implants, and CSF leakage or CSF drainage have been identified as independent risk factors for SSI.…”

mentioning

confidence: 99%

“…12 In cranial neurosurgery, male sex, age greater than 60 years, smoking, longer preoperative stay, an operative duration longer than 3 hours, emergency or repetitive surgery, contaminated surgery, the use of implants, and CSF leakage or CSF drainage have been identified as independent risk factors for SSI. 1,16,21,22,26,38,39 The most frequent organisms found in neurosurgical SSI were Staphylococcus aureus, Cutibacterium acnes, and coagulase-negative staphylococci (CoNS). 1,15,16,23,31,39 The identification of skin flora as the main source of infection directed the focus of our IPB and guided the selection of interventions.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Rubeli¹,

D’Alonzo²,

Mueller³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe objective of this study was to quantify surgical site infection (SSI) rates after cranial neurosurgery in a tertiary care hospital, identify risk factors for SSI, and evaluate the impact of standardized surveillance and an infection prevention bundle (IPB).METHODSThe authors compared SSI rates during 7 months before and after the intervention. The IPB included standardized patient preparation, perioperative antibiotic/antiseptic use, barrier precautions, coaching of surgeons, and the implementation of a specialized technical operation assistant team.RESULTSThree hundred twenty-two unselected consecutive patients were evaluated before the IPB, and 296 were evaluated after implementation. Infection rates after 1 year decreased from 7.8% (25/322) to 3.7% (11/296, p = 0.03) with similar mortality rates (14.7% vs 13.8%, p = 0.8). The isolated bacteria included Staphylococcus aureus (42%), Cutibacterium acnes (22%), and coagulase-negative staphylococci (14%). Organ/space infections dominated with 67%, and mostly consisted of subdural empyema and meningitis/ventriculitis. Among the 36 SSIs, 13 (36%) occurred during hospitalization, and 29 (81%) within the first 3 months of follow-up. In multivariable analysis including established risk factors described in the literature, non-CNS neoplasia (odds ratio [OR] 3.82, 95% confidence interval [CI] 1.39–10.53), postoperative bleeding (OR 4.09, 1.44–11.62), operations performed by or under supervision of a senior faculty surgeon (OR 0.38, 0.17–0.84), and operations performed after the implementation of standardized surveillance and an IPB (OR 0.38, 0.17–0.85) significantly influenced the infection rate.CONCLUSIONSThe introduction of an IPB combined with routine surveillance and personal feedback was associated with a 53% reduced infection rate. The lower infection rates of senior faculty and the strong association between postoperative bleeding and infection underline the importance of both surgical experience as well as thorough supervision and coaching of younger surgeons.

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Section: Discussionmentioning

confidence: 59%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Rubeli¹,

D’Alonzo²,

Mueller³

et al. 2019

Neurosurgical Focus

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show abstract

“…Operative duration is commonly cited in the literature as the most predictive risk factor for a SSI. 6,[13][14][15] Our model also showed that a longer operation significantly increased the risk of reoperation for subsequent SSIs. Any operation over 90 minutes more than doubled the risk.…”

Section: Operative Durationmentioning

confidence: 57%

Risk factors for surgical site infections in neurosurgery

Patel

Thompson

Innocent

et al. 2019

annals

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Introduction Surgical site infections (SSIs) are of profound significance in neurosurgical departments, resulting in high morbidity and mortality. There are limited public data regarding the incidence of SSIs in neurosurgery. The aim of this study was to determine the rate of SSIs (particularly those requiring reoperation) over a seven-year period and identify factors leading to an increased risk. Methods An age matched retrospective analysis was undertaken of a series of 16,513 patients at a single centre. All patients who required reoperation for suspected SSIs within a 7-year period were identified. Exclusion criteria comprised absence of infective material intraoperatively and patients presenting with primary infections. Clinical notes were reviewed to confirm presence or absence of suspected risk factors. Results Of the 16,513 patients in the study, 1.20% required at least one further operation to treat a SSI. Wound leak (odds ratio [OR]: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74) and operative duration >180 minutes (OR: 1.85) were statistically significant risk factors for reoperation. Conclusions This is the first UK study of such a duration that has documented a SSI reoperation rate in a cohort of this size. Various risk factors are associated with the development of SSIs, making it essential to have robust auditing and monitoring of high risk patients to ensure excellent standards of healthcare. Departmental and public registers to record all SSIs may be beneficial, particularly for those treated solely by general practitioners, allowing units to address potential risk factors prior to surgical intervention.

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“…Therefore, at our institution, located in New York City, the United States COVID-19 epicenter, we have applied the momentum gained introducing new infection control practices and procedures to prevent of COVID-19 transmission to the adoption of a surgical infection control bundle (Table 1). Implementation of a SSI control bundle has been previously shown to potentially reduce neurosurgery and spine SSI [16][17][18][19][20][21][22][23][24]. However, this effort requires a multi-disciplinary approach involving OR nurses and staff, anesthesia, infection control, and neurosurgeons.…”

Section: To the Editormentioning

confidence: 99%

Letter: Comprehensive Neurosurgery Infection Prevention and Control Practice in the COVID-19 “Return to Operate” Era

Maragkos¹,

McNeill²,

Kessler³

et al. 2021

Journal of Scientific Innovation in Medicine

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The COVID-19 pandemic has forced neurosurgeons to adapt in the face of an unforeseen crisis, including reevaluating an important aspect of neurosurgical practice: surgical infection control and prevention. Before COVID-19, surgical site infections (SSI) remained a costly and burdensome issue within neurosurgery and the medical field at-large. Furthermore, as options for linking payment to quality of care and mandatory reporting of SSI expands, cranial and spine surgery can expect to face increased oversight and pressure in efforts to reduce SSI. The risk of COVID-19 transmission to both patients and healthcare workers has inspired rigorous attention to inspection control practices. Therefore, at our institution we have applied the momentum gained introducing new infection control practices and procedures to prevent of COVID-19 transmission to the adoption of a surgical infection control bundle. We describe our implementation spanning screening and selection of patients for surgery, intraoperative precautions, postoperative care, and systems for monitoring and feedback.

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Reduction of Surgical Site Infections After Cranioplasty With Perioperative Bundle

Abstract: A perioperative bundle and monitoring system may help to reduce SSI rates after cranioplasty. This work also indicates how an active surveillance program can successfully change clinical practice.

Cited by 15 publications

References 23 publications

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

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

Risk factors for surgical site infections in neurosurgery

Letter: Comprehensive Neurosurgery Infection Prevention and Control Practice in the COVID-19 “Return to Operate” Era

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