Preoperative Prevention of Surgical-Site Infection in Spine Surgery

Abstract

Surgical-site infections (SSI) contribute to increased hospital length of stay, readmission rates, cost, and morbidity and mortality rates. The spine service line at a suburban Level II trauma center encountered 2 SSIs among the spine fusion population within a 6-month period. This did not meet the organization's internal benchmark of zero. A pilot quasi-experimental design was used to determine whether preoperative cleansing with 2% chlorhexidine gluconate (CHG)–impregnated cloths versus current practice of bathing with 4% CHG solution would reduce SSIs. Infection rates were measured using simple percentages. Level of significance was p < .05. Outcome data showed a reduction in SSIs from 3.9% to 1.9% with use of 2% CHG-impregnated cloths. There was no significant difference found between the use of 2% CHG-impregnated cloths and 4% CHG solution (p = .524). This quality improvement change, combined with a strengthened preoperative bundle approach, has permanently been adopted within the spine service line. From October 2017 to March 2021, the spine service line has had zero SSIs within the spine fusion population.

Best Practices and a Business Case for Surgical Site Infection Prevention

“…Chlorhexidine gluconate bathing products are available as impregnated cloths in a 2% concentration or liquid soap in a 4% concentration. Although the results are not generalizable, SSI rates after a quality improvement project involving both products were not significantly different 28 . In some situations (eg, lack of mobility), patients may find applying the 2% CHG‐impregnated cloths to be easier than showering or bathing with the 4% CHG solution.…”

“…Although the results are not generalizable, SSI rates after a quality improvement project involving both products were not significantly different. 28 In some situations (eg, lack of mobility), patients may find applying the 2% CHG-impregnated cloths to be easier than showering or bathing with the 4% CHG solution. When determining the products to use in a facility and creating a standardized SSI-prevention protocol, perioperative leaders and nurses should collaborate on an interdisciplinary team that includes physicians and infection preventionists.…”