• Michael Mann, Christina Huang Wright, Tarun Jella, Collin M Labak, Berje Shammassian, Shaarada Srivatsa, James Wright, Lilly Engineer, Martha Sajatovic, and Warren Selman.
• Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
• World Neurosurg. 2021 Apr 1; 148: 206-219.e4.

BackgroundCranial 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.ObjectiveTo identify and characterize interventions or bundled interventions aimed at reduction of the incidence of cranial surgical site infections.MethodsA 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.ResultsThe 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.ConclusionsThe 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.Copyright © 2021 Elsevier Inc. All rights reserved.

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