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 Staphylococcus 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 undergoing elective neurosurgical procedures at Conemaugh 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 presurgical protocol with measuring of HbA1c and nasal swabs revealed a significant decrease in the infection rate of patients undergoing elective neurosurgical procedures. Additional investigations are necessary; however, we recommend its use.

Automated summary

In this study, a retrospective review was conducted to evaluate the effectiveness of a presurgical protocol in reducing surgical site infections in elective neurosurgical patients. The protocol included screening patients using HbA1c and nasal swabs, and treating positive cases with mupirocin ointment. The results showed a significant decrease in infection rate after implementing the protocol.