An empiric analysis of 5 counter measures against surgical site infections following spine surgery-a pragmatic approach and review of the literature.
Anti-Bacterial Agents
/ administration & dosage
Antibiotic Prophylaxis
/ economics
Cost-Benefit Analysis
Humans
Laminectomy
/ adverse effects
Spine
/ surgery
Staphylococcal Infections
/ prevention & control
Surgical Wound Infection
/ prevention & control
Therapeutic Irrigation
/ economics
Vancomycin
/ administration & dosage
Betadine irrigation
Chlorhexidine scrubs
Nasal swab S. aureus decolonization
Perioperative antibiotics
Surgical site infection
Vancomycin powder
Journal
The spine journal : official journal of the North American Spine Society
ISSN: 1878-1632
Titre abrégé: Spine J
Pays: United States
ID NLM: 101130732
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
11
03
2018
revised:
04
05
2018
accepted:
30
05
2018
pubmed:
5
6
2018
medline:
7
1
2020
entrez:
5
6
2018
Statut:
ppublish
Résumé
Surgical site infections (SSI) following spine surgery are debilitating complications to patients and costly to the healthcare system. Review the impact and cost effectiveness of 5 SSI prevention interventions on SSI rates in an orthopedic spine surgery practice at a major quaternary healthcare system over a 10-year period. Retrospective observational study. All of the surgical patients of the 5 spine surgeons in our department over a 10-year period were included in this study. SSI rates per year, standardized infection ratios (SIR) for laminectomies and fusions during the most recent 3-year period, year of implementation, and frequency of use of the different interventions, cost of the techniques. The SSI prevention techniques described in this paper include application of intrawound vancomycin powder, wound irrigation with dilute betadine solution, preoperative chlorhexidine gluconate scrubs, preoperative screening with nasal swabbing, and decolonization of S. aureus, and perioperative antibiotic administration. Our institution's infection prevention and control data were analyzed for the yearly SSI rates for the orthopedic spine surgery department from 2006 to 2016. In addition, our orthopedic spine surgeons were polled to determine with what frequency and duration they have been using the different SSI prevention interventions. SSI rates decreased from almost 6% per year the first year of observation to less than 2% per year in the final 6 years of this study. A SIR of less than 1.0 for each year was observed for laminectomies and fusions for the period from 2013 to 2016. All surgeons polled at our institution uniformly used perioperative antibiotics, Hibiclens scrub, and the nasal swab protocol since the implementation of these techniques. Some variability existed in the frequency and duration of betadine irrigation and application of vancomycin powder. A cost analysis demonstrated these methods to be nominal compared with the cost of treating a single SSI. It is possible to reduce SSI rates in spine surgery with easy, safe, and cost-effective protocols, when implemented in a standardized manner.
Sections du résumé
BACKGROUND CONTEXT
Surgical site infections (SSI) following spine surgery are debilitating complications to patients and costly to the healthcare system.
PURPOSE
Review the impact and cost effectiveness of 5 SSI prevention interventions on SSI rates in an orthopedic spine surgery practice at a major quaternary healthcare system over a 10-year period.
STUDY DESIGN
Retrospective observational study.
PATIENT SAMPLE
All of the surgical patients of the 5 spine surgeons in our department over a 10-year period were included in this study.
OUTCOME MEASURES
SSI rates per year, standardized infection ratios (SIR) for laminectomies and fusions during the most recent 3-year period, year of implementation, and frequency of use of the different interventions, cost of the techniques.
METHODS
The SSI prevention techniques described in this paper include application of intrawound vancomycin powder, wound irrigation with dilute betadine solution, preoperative chlorhexidine gluconate scrubs, preoperative screening with nasal swabbing, and decolonization of S. aureus, and perioperative antibiotic administration. Our institution's infection prevention and control data were analyzed for the yearly SSI rates for the orthopedic spine surgery department from 2006 to 2016. In addition, our orthopedic spine surgeons were polled to determine with what frequency and duration they have been using the different SSI prevention interventions.
RESULTS
SSI rates decreased from almost 6% per year the first year of observation to less than 2% per year in the final 6 years of this study. A SIR of less than 1.0 for each year was observed for laminectomies and fusions for the period from 2013 to 2016. All surgeons polled at our institution uniformly used perioperative antibiotics, Hibiclens scrub, and the nasal swab protocol since the implementation of these techniques. Some variability existed in the frequency and duration of betadine irrigation and application of vancomycin powder. A cost analysis demonstrated these methods to be nominal compared with the cost of treating a single SSI.
CONCLUSIONS
It is possible to reduce SSI rates in spine surgery with easy, safe, and cost-effective protocols, when implemented in a standardized manner.
Identifiants
pubmed: 29864545
pii: S1529-9430(18)30269-9
doi: 10.1016/j.spinee.2018.05.043
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Vancomycin
6Q205EH1VU
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
267-275Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.