• World Neurosurg · Aug 2022

    A preoperative protocol to reduce SSI rates in elective neurosurgical procedures.

    • Siddhartha Nannapaneni, Mark Satkovich, William Aukerman, Daniel Urias, Shawna Morrissey, Kevin Zitnay, and Francis T Ferraro.
    • Duke LifePoint Conemaugh Memorial Medical Center, Johnstown, Pennsylvania. Electronic address: snannapa@conemaugh.org.
    • World Neurosurg. 2022 Aug 1; 164: 341-346.

    ObjectiveSurgical site infections (SSIs) are the most common and costly of all hospital-acquired infections, occurring in 5 percent of patients and accounting for 20% of all hospital-acquired infections. Preoperatively, we developed a protocol where patients were screened using hemoglobin A 1c (HbA1c) and nasal swabs. If HbA1c was greater than 9, patients were rescheduled for surgery when their HbA1c was less than 9. All patients then underwent nasal swabs to identify methicillin-sensitive Staphylococcus aureus/methicillin-resistant S. aureus in addition to standard chlorhexidine gluconate bathing. If positive, mupirocin ointment was used to treat the patients 5 days prior to surgery. We sought to measure the effectiveness of this protocol in reducing SSI in elective neurosurgical patients who were undergoing hardware implantation or had a procedure anticipated to last greater than 2 hours.MethodsThis was a retrospective review of patients undergoing elective neurosurgical procedures at Conemaugh Memorial Medical Center from 1/1/2014 to 06/30/2016. The intervention period was from 7/1/2016 to 12/20/2018, which included the patients undergoing the protocol.ResultsThe preintervention group consisted of 817 cases with a 2.7% infection rate (22 SSIs). The intervention group consisted of 822 cases with a 0.1% infection rate (1 SSI). This observed difference was statistically significant (P = 0.003).ConclusionsThis retrospective review of a presurgical protocol with measuring of HbA1c and nasal swabs revealed a significant decrease in the infection rate of patients undergoing elective neurosurgical procedures. Additional investigations are necessary; however, we recommend its use.Copyright © 2022 Elsevier Inc. All rights reserved.

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