Prevention of Surgical Site Infection in Spine Surgery

Abstract

BACKGROUND: Spine surgery is complicated by an incidence of 1% to 9% of surgical site infection (SSI). The most common organisms are gram-positive bacteria and are endogenous, that is are brought to the hospital by the patient. Efforts to improve safety have been focused on reducing SSI using a bundle approach. The bundle approach applies many quality improvement efforts and has been shown to reduce SSI in other surgical procedures. OBJECTIVE: To provide a narrative review of practical solutions to reduce SSI in spine surgery. METHODS: Literature review and synthesis to identify methods that can be used to prevent SSI. RESULTS: SSI prevention starts with proper patient selection and optimization of medical conditions, particularly reducing smoking and glycemic control. Screening for staphylococcus organisms and subsequent decolonization is a promising method to reduce endogenous bacterial burden. Preoperative warming of patients and timely administration of antibiotics are critical to prevent SSI. Skin preparation using chlorhexidine and alcohol solutions are recommended. Meticulous surgical technique and maintenance of sterile techniques should always be performed. Postoperatively, traditional methods of tissue oxygenation and glycemic control remain essential. Newer wound care methods such as silver impregnation dressing and wound-assisted vacuum dressing are encouraging but need further investigation. CONCLUSION: Significant reduction of SSIs is possible, but requires a systems approach involving all stakeholders. There are many simple and low-cost components that can be adjusted to reduce SSIs. Systematic efforts including understanding of pathophysiology, prevention strategies, and system-wide quality improvement programs demonstrate significant reduction of SSI.

Evaluation of Cumulative and Conditional Antibiotic Release from Vancomycin-Embedded Fibrin Sealant and Its Antibacterial Activity : An In Vitro Study

“…First, direct antibiotic powder application is one of the easiest methods to reduce postoperative infection in both cranial and spinal surgery 3,11,12,26,29,30) . Direct powder application is valuable for cost saving by reducing repeat admission and extra surgeries 11) .…”

“…SSI occurs in 1.9% of surgeries, and varies among populations, surgical procedures, and instrumentation 3,10,12,13,15,24) . SSI results in a significant morbidity and financial burden due to longer hospital stay, readmission, and repeated procedures 3,5,18,34) . Even though most surgeons do their best to prevent it, SSI is still a challenging issue.…”

A retrospective analysis of factors affecting surgical site infection in orthopaedic patients

“…Surgical site infection (SSI) is one of the most common complications after orthopaedic and other surgeries. [1][2][3][4] In recent years, with the improvement of orthopaedic surgical techniques, the treatment of bone injury has evolved significantly and surgical treatments have been increasingly adapted to treat many bone diseases that were previously treated conservatively. Increased orthopaedic indications, complexity of orthopaedic surgery and use of implants in orthopaedic surgery all contribute to the risk of SSI.…”

Updates on Evidence-Based Practices to Reduce Preoperative and Intraoperative Contamination of Implants in Spine Surgery: A Narrative Review

“…[2][3][4][5] In 2017, Anderson et al presented a thorough review on various preventative techniques being employed or advocated in the field of spine surgery, with varying level of evidences for each. 6 Their narrative review recommended systematic approach from proper patient selection and optimization of medical conditions, particularly reducing smoking and glycemic control, to screening for staphylococcus organisms, and subsequent decolonization is a promising method to reduce endogenous bacterial burden. 6 They categorized preoperative measures to further include warming of patients, skin preparation using chlorhexidine and alcohol solutions, and timely administration of antibiotics.…”

“…6 Their narrative review recommended systematic approach from proper patient selection and optimization of medical conditions, particularly reducing smoking and glycemic control, to screening for staphylococcus organisms, and subsequent decolonization is a promising method to reduce endogenous bacterial burden. 6 They categorized preoperative measures to further include warming of patients, skin preparation using chlorhexidine and alcohol solutions, and timely administration of antibiotics. 6 Following this was meticulous surgical technique and maintenance of "standard" sterile techniques.…”