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Analysis of a ten step protocol to decrease postoperative spinal wound infections.

Hossein Elgafy1, Craig J Raberding2, Megan L Mooney2

  • 1Department of Orthopedics and Infectious Diseases, University of Toledo Medical Center, Toledo, OH 43614, United States. hkelgafy@aol.com.

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|November 28, 2018
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Summary
This summary is machine-generated.

A ten-step protocol significantly reduced surgical site infections in spine surgery. Key steps include preoperative glycemic control, chlorhexidine preparation, and vancomycin powder, supported by literature for infection prevention.

Keywords:
SpineSurgical site infectionsTen step protocolWound infections

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Area of Science:

  • Spine Surgery
  • Infectious Disease Control
  • Surgical Protocols

Background:

  • Increased surgical site infection (SSI) rates in spine surgery necessitate improved preventative strategies.
  • Existing literature supports various measures for SSI reduction, but a standardized protocol is often lacking.

Purpose of the Study:

  • To define and evaluate a ten-step protocol aimed at reducing SSIs in spine surgery.
  • To assess the existing literature supporting each component of the defined protocol.

Main Methods:

  • Implementation of a ten-step protocol including preoperative glycemic control (HbA1c), chlorhexidine skin preparation, OR traffic/personnel limitation, no flash sterilization, double-gloving, vancomycin powder, adjusted antibiotic dosing/duration, povidone-iodine irrigation, and end-of-case DuraPrep.
  • Extensive literature review to evaluate evidence supporting each of the ten protocol steps.

Main Results:

  • Strong literature support exists for vancomycin powder, surgical site irrigation, frequent glove changes, and chlorhexidine preoperative preparation.
  • Evidence supports preoperative glycemic control (HbA1c) and limiting OR traffic/personnel, though level 1 evidence is limited for the latter.
  • Literature does not support prolonged postoperative antibiotics; DuraPrep use prior to skin closure remains unexplored.

Conclusions:

  • The implemented ten-step protocol effectively decreased surgical site infection rates in spine surgery.
  • Several protocol components are well-supported by existing literature for infection prevention.
  • Standardizing a comprehensive protocol encompassing these ten steps appears beneficial for reducing SSIs.