Infection reduction bundle may reduce surgical site infection rate
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Implementation of an infection reduction bundle may reduce the overall surgical site infection rate among pediatric patients undergoing spinal fusion, according to results.
R. Justin Mistovich, MD, MBA, and colleagues compared the incidence of early and late surgical site infections during the first postoperative year among 804 patients 21 years of age or younger with a diagnosis of idiopathic, neuromuscular, syndromic or congenital scoliosis and who had a primary spinal fusion or a same-day anterior and posterior spine fusion with segmental spinal instrumentation of six levels of more, and a minimum of 1- year postoperative follow-up. Researchers categorized patients into groups based on whether they were treated prior to (n=404; non-bundle group) or after (n=400; bundle group) the implementation of a comprehensive standardized infection reduction bundle.
Infection reduction bundle
Implemented in 2008, the researchers noted the infection reduction bundle intervention included preoperative nares screening for MRSA or methicillin sensitive Staphylococcus aureus approximately 2 weeks before surgery and treatment with intranasal mupirocin when positive. In addition, the intervention also included:
- a chlorohexidine bath or shower the night before surgery;
- a preoperative chlorohexidine scrub immediately before surgery;
- timing of standardized antibiotic administration;
- standardized intraoperative redosing of antibiotics;
- limiting OR traffic; and
- standardized postoperative wound care.
The bundle was updated in 2011 to include intrawound vancomycin powder at the time of wound closure, according to researchers.
Reduction in surgical site infections
Results showed 7.2% of patients in the non-bundle group had infections vs. 2.5% of patients in the bundle group. Mistovich said this drop in the overall rate of surgical site infections after implementation of the infection reduction bundle was statistically significant.
“We were unable to demonstrate statistical significance between the rates of early vs. late [surgical site infections] SSIs as subgroups when compared to pre-bundle patients, but this may be a limitation of our lower number of SSIs overall,” Mistovich told Healio Orthopedics.
He added that they have had no single, early surgical site infections since 2015.
“A methodical, standardized approach to SSI reduction is important in pediatric spinal deformity surgery, and likely applicable to the entirety of our field. It is challenging to get good data on individual interventions that may lower SSIs,” Mistovich said. “To have a protocol that is unchanged except for one specific intervention, and then keeping this constant to get good data among two large cohorts of patients before and after the intervention was added — this is unrealistic for most centers, but what would be necessary to get meaningful evidence for single interventions. Yet, simply because we cannot get clinical evidence easily for these individual modalities does not mean that basic science should not be employed. We’ve demonstrated that a thoughtful approach utilizing basic science and a standardized methodology can collectively lower SSIs.” – by Casey Tingle
Reference:
Shimberg J, et al. ePaper 275. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Mistovich reports he is a paid consultant for Orthopediatrics; is a board or committee member for the Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine; and has stock or stock options in Right Mechanics Inc.
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