Implementation of a care bundle and evaluation of risk factors for surgical site infection in cranial neurosurgery

Objectives: Surgical site infection [SSI] increases mortality, morbidity and length of hospital stay. Perioperative 'care bundles' have reduced SSI in some fields of surgery. The aim of this study was to determine the impact of bundle compliance on SSI in patients undergoing a craniotomy. Patients and method: Cohort study of patients [N =1253] undergoing a craniotomy over 17 months at a single centre. SSI was defined as arising within 30 days of operation or 1 year where an implant(s) remains. 'Bundle compliance' required administration of antibiotics <60 min of induction, maintenance of intraoperative blood sugar (BM) <11 mmol and temperature at >36 degrees C. SSI incidence was compared between bundle compliant and non-compliant groups. Case mix adjustment was performed using binary logistic regression. Results: Over the study period, 1253 procedures were carried out and 66 patients (5.3%) developed a SSI. The majority (38, 57.6%) of these cultured Staphyloccoccus species. Only the use of an implant was found to be an independent risk factor for SSI [AOR 2.5, p < 0.005, 95%CI 1.4, 4.3]. The use of the bundle did not reduce the occurrence of SSI. Conclusions: An evidence-based bundle did not reduce SSI in this neurosurgical series. The use of an implant was an independent risk factor of its occurrence. (C) 2016 Elsevier B.V. All rights reserved.