Cranial Surgical Site Infection Interventions and Prevention Bundles: A Systematic Review of the Literature.

Anti-Bacterial Agents / therapeutic use Guidelines as Topic Humans Neurosurgical Procedures / adverse effects Skull / surgery Surgical Wound Infection / drug therapy Vancomycin / therapeutic use
Cranial Craniotomy Infection Infection prevention bundles Postoperative infection Quality Surgical site infection

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
04 2021
Historique:
received: 15 11 2020
accepted: 27 12 2020
pubmed: 8 1 2021
medline: 17 7 2021
entrez: 7 1 2021
Statut: ppublish

Résumé

Cranial surgical site infections (cSSIs) are associated with significant morbidity. Measures to reduce cSSI are necessary to reduce patient morbidity as well as hospital costs and resource utilization. To identify and characterize interventions or bundled interventions aimed at reduction of the incidence of cranial surgical site infections. A systematic review of the literature was conducted according to the PRISMA guidelines. The search strategy included randomized trials, quasi-experimental studies, cohort studies, and case series published between 2000 and 2020 that evaluated interventions implemented to reduce cSSI. Bias assessments and data extraction were performed on included studies. The initial search generated 1249 studies. Application of inclusion and exclusion criteria and review of references yielded 15 single-intervention and 6 bundled-intervention studies. The single interventions included handwashing protocols, use of vancomycin powder, hair washing and clipping practices, and incision closure techniques. Bundled interventions addressed a variety of preoperative, intraoperative, and postoperative changes. Despite a lack of strong evidence to support the adoption of statistically significant interventions, the use of vancomycin powder may be effective in reducing cSSI. In addition, bundled interventions that involved cultural changes, such as increased teaching/education, personal accountability, direct observation, and feedback, showed some success in decreasing SSI rates. The strength of the conclusions is limited by small sample sizes, study heterogeneity, relatively low cSSI incidence, and high case variability. Some evidence supports the use of intraoperative vancomycin powder in adult noncranioplasty cases and the application of accountability, teaching, and surveillance of faculty, particularly those early in training.

Sections du résumé

BACKGROUND
Cranial surgical site infections (cSSIs) are associated with significant morbidity. Measures to reduce cSSI are necessary to reduce patient morbidity as well as hospital costs and resource utilization.
OBJECTIVE
To identify and characterize interventions or bundled interventions aimed at reduction of the incidence of cranial surgical site infections.
METHODS
A systematic review of the literature was conducted according to the PRISMA guidelines. The search strategy included randomized trials, quasi-experimental studies, cohort studies, and case series published between 2000 and 2020 that evaluated interventions implemented to reduce cSSI. Bias assessments and data extraction were performed on included studies.
RESULTS
The initial search generated 1249 studies. Application of inclusion and exclusion criteria and review of references yielded 15 single-intervention and 6 bundled-intervention studies. The single interventions included handwashing protocols, use of vancomycin powder, hair washing and clipping practices, and incision closure techniques. Bundled interventions addressed a variety of preoperative, intraoperative, and postoperative changes. Despite a lack of strong evidence to support the adoption of statistically significant interventions, the use of vancomycin powder may be effective in reducing cSSI. In addition, bundled interventions that involved cultural changes, such as increased teaching/education, personal accountability, direct observation, and feedback, showed some success in decreasing SSI rates.
CONCLUSIONS
The strength of the conclusions is limited by small sample sizes, study heterogeneity, relatively low cSSI incidence, and high case variability. Some evidence supports the use of intraoperative vancomycin powder in adult noncranioplasty cases and the application of accountability, teaching, and surveillance of faculty, particularly those early in training.

Identifiants

DOI: 10.1016/j.wneu.2020.12.137 PMID: 33412319
pubmed: 33412319
pii: S1878-8750(20)32704-2
doi: 10.1016/j.wneu.2020.12.137
pii:
doi:

Substances chimiques

Anti-Bacterial Agents 0
Vancomycin 6Q205EH1VU

Types de publication

Journal Article Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

206-219.e4

Informations de copyright

Copyright © 2021 Elsevier Inc. All rights reserved.

Auteurs

Michael Mann (M)

Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Christina Huang Wright (CH)

Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Electronic address: christina.lee.huang@gmail.com.

Tarun Jella (T)

Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Collin M Labak (CM)

Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Berje Shammassian (B)

Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Shaarada Srivatsa (S)

Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

James Wright (J)

Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Lilly Engineer (L)

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Martha Sajatovic (M)

Department of Neurology, and Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Neurological and Behavioral Outcomes Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Warren Selman (W)

Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Cranial Surgical Site Infection Interventions...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Assurance de la qualité des soins de santé › Recommandations comme sujet › Cranial Surgical Site Infection Interventions...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Cranial Surgical Site Infection Interventions...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de neurochirurgie › Cranial Surgical Site Infection Interventions...
questionsmedicales.fr › Appareil locomoteur › Squelette › Crâne › Cranial Surgical Site Infection Interventions...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Infection de plaie opératoire › Cranial Surgical Site Infection Interventions...
questionsmedicales.fr › Acides aminés, peptides et protéines › Peptides › Glycopeptides › Vancomycine › Cranial Surgical Site Infection Interventions...