An Empiric Analysis of 5 Counter-measures Against Surgical Site Infections Following Spine Surgery—A Pragmatic Approach and Review of the Literature

Publication date: Available online 2 June 2018
Source:The Spine Journal
Author(s): Marko Tomov, Nathan Wanderman, Elie Berbari, Bradford Currier, Michael Yaszemski, Ahmad Nassr, Paul Huddleston, Mohamad Bydon, Brett Freedman
Background contextSurgical site infections (SSI) following spine surgery are debilitating complications to patients and costly to the healthcare system.PurposeReview the impact and cost effectiveness of five SSI prevention interventions on SSI rates in an orthopaedic spine surgery practice at a major quaternary healthcare system over a 10-year period.Study DesignRetrospective observational study.Patient SampleAll of the surgical patients of five spine surgeons in our department over a 10-year period were included in this study.Outcome MeasuresSSI 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.MethodsThe 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 (IPAC) data was analyzed for the yearly SSI rates for the orthopaedic spine surgery department from 2006-2016. In addition, our orthopaedic spine surgeons were polled to determined with what frequency and duration they have been using the different SSI prevention interventions.ResultsSSI rates decreased from almost 6% per year the first year of observation to less than 2% per year in the final six years of this study. A SIR of less than 1.0 for each year was observed for laminectomies and fusions for the 2013-2016 period. 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 to the cost of treating a single SSI.ConclusionsIt is possible to reduce SSI rates in spine surgery with easy, safe, and cost-effective protocols, when implemented in a standardized manner.



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