دورية
Efficacy of a Postoperative Infection Prevention Protocol in Spine Surgery
| العنوان: | Efficacy of a Postoperative Infection Prevention Protocol in Spine Surgery |
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| المؤلفون: | Pantoja, Samuel, Luna, Felipe, Hervé, Beatrice, Gutierrez, Cecilia, Postigo, Roberto |
| المصدر: | Global Spine Journal; April 2016, Vol. 6 Issue: Supplement 1 ps-0036-158-s-0036-158 |
| مستخلص: | Introduction post operatory wound infection is an unwanted complication of spine surgery. Infection rate ranges from 2.1 to 5.5%, and the consequences in some cases can be devastating for the patient and for the medical team. Material and Method:we compare post-operative wound infection incidence before and after the implementation of a wound infection prevention protocol specific for major spine surgery established in our Center in collaboration with the HealthCare Associated Infection Committee (HCAIC). Post operatory wound infection incidence was reviewed for 4 years after implementation. The protocol consisted on a 28 point check list, that included: skin preparation with chlorhexidine one day before surgery at home, and at entrance the morning of the surgery; strict control of blood glucose under 200mg/dL before surgery; programming instrumented surgeries preferably as the first surgery of the Operating Room (OR); OR with laminar air flow; OR temperature between 18°-22°C during surgery (64.4°-71.6°F); skin preparation with alcohol-based chlorhexidine and covering with adherent antimicrobial incise drapes at surgery; Cefazolin prophylaxis (or Clindamycin in case of β-lactam antibiotics allergy) no more than 60 minutes before skin incision and a new dose every 3 hours during surgery; strict control of patient temperature at 36°C(96.8F) with the aid of warming blankets (Bair Hugger®); maintaining a target Hemoglobin of 7–9 g/dL with restriction of blood transfusion indication; hematocrit and glycemia control after surgery and the morning after.Results After the introduction of the protocol we found a progressive reduction in the post operatory wound infection rate in spinal surgery from 2.89% in 2009 (before the protocol), to 2,5% in 2010, 1,71% in 2011 and 1.56% in 2012. During the surveillance made by the HCAIC, we observed a rise in the infection rate during 2013 (2.02%) which was associated with breaches in protocol adhesion. The relevance of the check list control by the OR nurse was reinforced and the strict control of patient temperature at 36°C(96.8F) with warming blankets used before, during surgery and in recovery room was added. With this new update and more strict control of protocol adhesion, we reduced the infections rate to 0.95% in 2014.Conclusion We consider that a wound infection prevention protocol specific for spine surgery, with proper surveillance and strict follow-up, is an effective way for reducing the infection rate in spine surgery. Although, the microbiological environment for every center is different, we think that this protocol can be used as a guide for centers were this complication becomes an issue. |
| قاعدة البيانات: | Supplemental Index |
Full Text Finder | تدمد: | 21925682 21925690 |
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| DOI: | 10.1055/s-0036-1582822 |