Choose Your Patients Wisely: A Preoperative Protocol to Reduce Surgical Site Infection Rates in Elective Neurosurgical Procedures

-OBJECTIVE: Surgical 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 Staphylo-coccus 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.-METHODS: This was a retrospective review of patients -ndergoing elective neurosurgical procedures at Con-emaugh 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.-RESULTS: The 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).-CONCLUSIONS: This retrospective review of a presur-gical protocol with measuring of HbA1c and nasal swabsrevealed a significant decrease in the infection rate of patients undergoing elective neurosurgical procedures. Additional investigations are necessary; however, we recommend its use.

Automated summary

By screening patients using HbA1c and nasal swabs, treating positively identified nasal bacterial patients with mupirocin ointment, a significant decrease in surgical site infection rate of elective neurosurgical patients was observed.