Prevention of orthopaedic infection in spine surgery

Abstract

Surgical infections in spine surgery is a complication that can delay wound-healing and recovery, add impairments and increase the morbidity, the mortality and the overall financial constraints 1,2 , Although the prophylaxis against infections has recently improved, the incidence of surgical site infections (SSI) varies from 0,7% to 16% 3. According to clinical studies, the postoperative wound-infections are the third most commonly hospital infections after pneumonia and urinary tract infection 1,2. The infection rate varies according to the relevant published literature, and risk factors are classified as: 1) patient-related factors and 2) procedure-related factors 1,2,4,5. The latter is further divided into: i) pre-operative, ii) intra-operative and iii) post-operative risk factors 1,6. The successful prevention of SSI is inevitably bound up coping with these risk-factors, as up to 60 % as SSIs are preventable by using evidence-based guidelines 1,6. Methods This review was based on literature obtained from MEDLINE PubMed, the Cochrane Library, Google scholar, medical books and the guidelines of Robert-Koch-Institut in Germany, as published in Springer journals. Background, definition, and classification The transfer of microorganisms to a surgical site causing consequently an inflammation is commonly called surgical site infection (SSI) 7. Very important for the prevention of SSIs is to understand the epidemiologicalbacteriological profile of SSIs, the pathogenesis of these infections as well as the wound and SSI classification. First of all, as SSIs are defined as all the infections that occur in a surgical site within in 1 month from the operation day or within 1 year for operations with spinal instrumentation. The infection rate of patients was found 3-5% lower in cases where the procedures involved clean wounds, compared with contaminated or dirty wounds and body cavities 8. The contamination classification 8,9 of surgical wounds includes 1) Clean wounds, mostly in elective cases with primary closure, without inflammation or invasion of the respiratory, the alimentary or the genitourinary tract. 2) Clean/contaminated wounds, were the procedure involves