Reducing Surgical Site Infection in Spinal Surgery With Betadine Irrigation and Intrawound Vancomycin Powder

Abstract

Study Design Retrospective analysis. Objective The objective of this study was to evaluate the efficacy of a surgical site infection (SSI) prevention protocol instituted in the Orthopaedic Spine Department at our institution. Summary of Background Data SSI is an undesired complication of orthopaedic spine surgeries. It poses a significant risk to the patient, as well as a financial toll on the healthcare system. A wide range of prophylactic measures have been used to attempt to reduce SSI rates. Methods A protocol consisting of a combination of 0.3% Betadine wound irrigation and 1 gram of intra-wound Vancomycin powder application was developed at our institution. Multiple data sources were consolidated for thorough evaluation of changes in SSI rates, patient risk factors, and changes in bacteriology. Identification of risk factors that predispose patients to SSI was performed using mixed effects logistic regression in a univariate fashion. Risk factors with p-values of ≤ 0.05 in univariate analysis were included together in a multivariate mixed effects logistic regression model. Results SSI rates were reduced by 50% following the intervention; Chi square analysis comparing the SSI rates between the pre- and post-intervention periods yielded a p-value of 0.042. Rates of methicillin resistant Staphylococcus aureus dropped from 30% to 7% and the rates of multi-bacterial infections dropped from 37% to 27%. The risk factors that were statistically significant in multivariate analysis were the following: age (OR 0.93), anemia (OR 30.73), prior operation (OR 27.45), and vertebral fracture (OR 22.22). Conclusion The combination of Betadine wound irrigation and intra-wound vancomycin powder application led to both a clinically and statistically significant decrease in SSI rates by 50%. Bacteriology analysis and risk factor assessment proved to be valuable tools in assessing the efficacy of a new prophylactic measure and in the planning of future protocols.

Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review

“…Tomov et al reviewed the use of intrawound vancomycin in spinal surgery in their retrospective series of 2325 patients, which included a historical comparative cohort. 26 An overall decline in the infection rate was noted, particularly in gram-positive organisms and methicillin-resistant S. aureus, with a respective 27% and 23% decrease of each. 26 The proportion of gram-negative and polymicrobial infections also decreased after the use of vancomycin, which can only be explained by significant differences in patient populations and operative durations with the use of historical controls.…”

“…Culture-negative seromas are uncommon and have been reported in increased numbers in 2 retrospective studies. 8,26 The cause-effect relationship has not been established between vancomycin and culturenegative seromas because high doses of intrawound vancomycin could theoretically sterilize the culture samples. Alternatively, further studies are needed to determine the causative relationship between vancomycin powder and related seromas.…”

Adverse Drug Reactions to Local Intrawound Vancomycin Application After Posterior Lumbosacral Fusion

“…Полимикробные ассоциации представлены преимуще-ственно грамотрицательной патоген-ной и условно-патогенной микрофло-рой: Pseudomonas, Proteus, Escherichia Coli, Corynebacteria. Tomov et al [30] провели ретроспективное исследова-ние, посвященное анализу эффектив-ности местного применения порош-ка ванкомицина в профилактике раз-вития ИОХВ у 2325 пациентов после оперативных вмешательств на позво-ночнике. Авторы доказали, что данный антибактериальный препарат позво-ляет достичь достоверного снижения частоты развития ИОХВ, вызванных грамположительными микроорганиз-мами, в частности MRSA.…”

The National Neurosurgery Quality and Outcomes Database Qualified Clinical Data Registry: 2015 measure specifications and rationale

“…In the intraoperative phase, impeccable surgical aseptic technique, the timing and selection of antibiotic prophylaxis, and minimizing blood transfusions are key processes. 60,65,66,89,102,144 In the postoperative phase, aseptic wound care and early detection of wound inflammation or breakdown contribute to prevention of delayed contamination and subsequent infection.…”