Current Concepts in Perioperative Care for the Prevention of Deep Surgical Site Infections in Elective Spinal Surgery

Abstract

Introduction: Postoperative deep wound infections are the third most common reason for nosocomial infections after pneumonia and urinary tract infections. Deep wound infections lead to higher rates of morbidity and mortality and increased costs of treatment. Infection rates following spinal surgery are reported to lie between 1.9 and 10%. This study was carried out to prove whether a new internal concept for perioperative management could reduce the infection rates following spinal surgery.

Methods: Based on the current literature we developed a concept for perioperative care in spinal surgery in order to prevent postoperative deep wound infections. We retrospectively compared infection rates of 2006 and 2007 after the implementation of our perioperative care concept in spinal surgery patients. Total annual operations were comparable.

Results: After the introduction of our predominantly evidence-based concept of perioperative care for spinal surgery patients, we found a considerable decrease in infection rates from 0.6% in 2006 to 0% in 2007.

Conclusion: A new concept for perioperative care in spinal surgery for the prevention of deep wound infections was found to effectively reduce infection rates. Due to the limitations of our single-center retrospectively selected cohort, further research is necessary to support our results.

Key words

perioperative - spine - surgery - infection

References

• 1 Bennett B, Duff P. The effect of double gloving on frequency of glove perforations.  Obstet Gynecol. 1991;  78 1019-1022
• 2 Breitner S, Ruckdeschel G. Bacteriologic studies of the use of incision drapes in orthopedic operations.  Unfallchirurgie. 1986;  12 301-304
• 3 Brökelmann J RJ. Zahl der Operationen in Deutschland 2003 – eine Annäherung.  ambulant operieren. 2005;  2 95-102
• 4 Culver DH, Horan TC, Gaynes RP. et al . Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System.  Am J Med. 1991;  91 S152-S157
• 5 de Boer AS, Mintjes-de Groot AJ, Severijnen AJ, van den Berg JM, van Pelt W. Risk assessment for surgical-site infections in orthopedic patients.  Infect Control Hosp Epidemiol. 1999;  20 402-407
• 6 De Lalla F. Perioperative antibiotic prophylaxis: a critical review.  Surg Infect (Larchmt). 2006;  7 ((Suppl 2)) S37-S39
• 7 Elek SD, Conen PE. The virulence of Staphylococcus pyogenes for man; a study of the problems of wound infection.  Br J Exp Pathol. 1957;  38 573-586
• 8 Gause PR, Siska PA, Westrick ER. et al. . Efficacy of intraoperative cell saver in decreasing postoperative blood transfusions in instrumented posterior lumbar fusion patients.  Spine. 2008;  33 571-575
• 9 Kampf G, Gastmeier P, Wischnewski N. et al . Nosocomial infections in Germany – assessment and prevention.  NIDEP Study, 1: On prevalence in surgery. Chirurg. 1996;  67 637-642
• 10 Kanayama M, Hashimoto T, Shigenobu K. et al. . Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery.  J Neurosurg Spine. 2007;  6 327-329
• 11 Katthagen BD, Zamani P, Jung W. Effect of surgical draping on bacterial contamination in the surgical field.  Z Orthop Ihre Grenzgeb. 1992;  130 230-235
• 12 McAnally HB, Cutter GR, Ruttenber AJ. et al. . Hypothermia as a risk factor for pediatric cardiothoracic surgical site infection.  Pediatr Infect Dis J. 2001;  20 459-462
• 13 Meylan G, Tschantz P. Surgical wounds with or without dressings. Prospective comparative study.  Ann Chir. 2001;  126 459-462
• 14 Niel-Weise BS, Wille JC, van den Broek PJ. Hair removal policies in clean surgery: systematic review of randomized, controlled trials.  Infect Control Hosp Epidemiol. 2005;  26 923-928
• 15 Oldhafer K JU, Kramer A, Martius J. et al. . Prävention postoperativer Infektionen im Operationsgebiet – Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut.  Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz. 2007;  50 377-393
• 16 Orsi GB, Ferraro F, Franchi C. Preoperative hair removal review.  Ann Ig. 2005;  17 401-412
• 17 Ramos M, Khalpey Z, Lipsitz S. et al . Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery.  Ann Surg. 2008;  248 585-591
• 18 Ritter EF, Demas CP, Thompson DA. et al. . Effects of method of hemostasis on wound-infection rate.  Am Surg. 1990;  56 648-650
• 19 Simchen E, Rozin R, Wax Y. The Israeli study of surgical infection of drains and the risk of wound infection in operations for hernia.  Surg Gynecol Obstet. 1990;  170 331-337
• 20 Weinstein MA, McCabe JP, Cammisa FP, Jr. Postoperative spinal wound infection: a review of 2 391 consecutive index procedures.  J Spinal Disord. 2000;  13 422-426

Correspondence