Issue: October 2015
September 01, 2015
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Active surveillance significantly reduces SSI rates after neurosurgery

Issue: October 2015
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The postoperative period for neurosurgery patients is associated with risk factors for surgical site infection that may go unnoticed, but active surveillance during this time appeared to reduce infection rates, according to recent study data.

In a prospective cohort study, researchers from France evaluated 949 adult patients who underwent neurosurgery at the University Nord Hospital in Marseille from January 2009 through December 2010. They analyzed the rates, types and primary risk factors of surgical site infections (SSIs) during the postoperative period.

Forty-three patients were diagnosed with SSI during the study period. Between 2009 and 2010, there was a decrease in postoperative neurosurgical SSI — from 5.8% to 3% (P = .04). During this interval, the hospital also developed an active surveillance with quarterly feedback.

The most common SSI microorganisms identified were Staphylococcus aureus (23%), Enterobacteriaceae (21%) and Propionibacterium acnes (12%).

The researchers identified several “overlooked risk factors” for postoperative SSIs in patients who underwent cranial surgery. These included an ICU length of stay of 7 days or longer (OR = 6.1; 95% CI, 1.7-21.7), drainage lasting at least 3 days (OR = 3.3; 95% CI, 1.1-11) and leakage of cerebrospinal fluid (OR = 5.6; 95% CI, 1.1-30).

In cases of SSI after spinal surgery, independent risk factors included: an ICU length of stay of 7 days or longer (OR = 7.2; 95% CI, 1.6-32.1), coinfection (OR = 9.9; 95% CI, 2.2-43.4) and drainage duration of 3 days or more (OR = 5.7; 95% CI, 1.5-22).

According to the researchers, the reduction in SSIs seen during this 2-year period may be attributable to the introduction of active surveillance.

“Effective infection control programs should include an adequate number of trained infection control staff and a system for sustained reporting of SSI rates to surgeons,” the researchers wrote. “Infection control measures during the postoperative period represent a window of opportunity to improve the management of neurosurgical patients and to decrease their incidence of SSI.” – by Jen Byrne

Disclosure: The researchers report no relevant financial disclosures.