Measures to prevent surgical site infections in neurosurgery: Survey and comparative analysis

Surgical site infections (SSI) are among the most common type of healthcare-associated infections and are involved with an increase in morbidity, mortality and higher healthcare costs.

The Observatory of Infection in Surgery has conducted a survey to assess the level of awareness and implementation of the preventive measures for SSI. A 64-question questionnaire was given to SENEC (Sociedad Española de Neurocirugía) members.

The survey was answered by 123 neurosurgeons. There is a gap between clinical guidelines and neurosurgery practice (67%), even though neurosurgeons place a high value on international (81.7%) or national (78.7%) clinical guidelines. There are still practices not supported by scientific evidence that some of our respondents follow, including antibiotic prophylaxis≥24h (10.6%), the habit of not allowing the antiseptic solution to air dry (38.2%) or the use of transparent plastic adhesive drape on the surgical field (77.4%). The most widespread practice for hair management is the selective removal from the surgical area (83.3%). It is most commonly performed by the neurosurgeon himself, in the operating room, which is a significant difference from the use of other surgical specialties (68.5% vs 3.5%, P<.001). There are only 37% of respondents who use alcohol solutions. Double-gloving is utilised by 16.7% of neurosurgeons. The usual use of drainage is quite widespread (60.7%), while the rate of nutritional assessment prior to major surgery is very low (7.5%). Only 37.2% report providing feedback on SSI rates to surgical teams, and a small 16.5% have received specific training programmes on SSI.

Scientific evidence-supported measures are not fully incorporated into neurosurgical practice, and there is a lack of specific training in surgical infection prevention. Additionally, a specific issue has been identified, particularly regarding hair management. Neurosurgeons should actively participate in SSI prevention programmes and analyse the reasons why they do not implement certain strategies into their clinical practice.