• Emilio Jiménez-Martínez, Guillermo Cuervo, Jordi Carratalà, Ana Hornero, Pilar Ciercoles, Andres Gabarrós, Carmen Cabellos, Ivan Pelegrin, Maria Angeles Dominguez Luzón, Dolores García-Somoza, Jordi Càmara, Cristian Tebé, Jordi Adamuz, and Miquel Pujol.
• Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
• Clin. Infect. Dis. 2020 Jun 28.

BackgroundAlthough surgical site infections after a craniotomy (SSI-CRAN) are a serious problem involving significant morbidity and costs, information on their prevention is scarce. We aimed to assess whether the implementation of a care bundle was effective in preventing SSI-CRANs.MethodsA historical control study was used to evaluate the care bundle, which included a preoperative shower with 4% chlorhexidine soap, appropriate hair removal, adequate preoperative systemic antibiotic prophylaxis, the administration of 1 g of vancomycin powder into the subgaleal space before closing, and a post-operative dressing of the incisional surgical wound with a sterile absorbent cover. Patients were divided into 2 groups: pre-intervention (January 2013 to December 2015) and intervention (from January 2016 to December 2017). The primary study endpoint was the incidence of SSI-CRANs within a year post-surgery. Propensity score matching was performed and differences between the two study periods were assessed using Cox regression models.ResultsA total of 595 and 422 patients were included in the pre-intervention and intervention periods, respectively. The incidence of SSI-CRANs was lower in the intervention period (15.3% vs. 3.5%; p < 0.001). Using a propensity score model, 421 pairs of patients were matched. The care bundle intervention was independently associated with a reduced incidence of SSI-CRANs (AOR: 0.23, 95% CI: 0.13-0.40; p < 0.001).ConclusionThe care bundle intervention was effective in reducing SSI-CRAN rates. The implementation of this multimodal preventive strategy should be considered in centers with high SSI-CRAN incidences.© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

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