Introduction: Surgical site infection (SSI) after spinal surgery can have substantial medical, social, and financial impacts on patients. Prevention of SSI after spine surgery is a major area of interest as surgical complications may negatively impact reimbursements to hospitals under the current and future regulatory environment. The Centers for Disease Control (CDC) has published specific definitions for SSIs. Hospitals are required to report their incident rate of SSI to Medicare on a quarterly basis. The National Healthcare Safety Network records this data and allows institutions across the country to track and compare infection rates.
The authors at a single institution in New England undertook an effort to reduce surgical site infections with the implementation of a spine surgical site infection bundle.
Methods: The authors prospectively identified nine elements for the spinal surgery infection bundle were identified by the surgeons, reviewed with the operating room staff, and amended based on feedback.
Results: For spinal fusion, the first quarter following implementation revealed a 0.76% reduction in our rate of infection, when compared to the prior calendar year.
Our year to date SSI averages for the first three quarters of 2013 are 1.13% for fusion, and .62% for laminectomy/otomy. These averages represent a reduction compared to our calendar 2012 rates for both procedures.
Conclusions: The authors developed a specific SSI bundle to be used with patients having spinal surgery, educated our surgeons and OR staff, and observed and gave feedback to surgeons on compliance. Initial data reveals a reduction in surgical site infection rates for spinal surgery. Longitudinal experience with the bundle will allow us to understand the durability of this intervention.
Patient Care: The elimination of surgical site infection for patients who have spinal surgery will improve patient care.
Learning Objectives: By the conclusion of the session, participants should be able to: 1) appreciate the use of a surgical site infection bundle in reducing infection, 2) understand the process for developing a surgical site infection bundle with a group of surgeons, providers, and OR staff, 3) appreciate the ongoing monitoring and reporting of compliance to the bundle, 4) review of initial data regarding the impact of the bundle on our infection rate, 5) provide feedback and suggestions with respect to the surgical site infection bundle.
References: 1. Eur Spine J. Oct 2010; 19(10): 1711–1719.
Published online May 6, 2010. doi: 10.1007/s00586-010-1421-y
Risk factors for deep surgical site infections after spinal fusion
J. J. P. Schimmel, 1 P. P. Horsting,2 M. de Kleuver,2 G. Wonders,1 and J. van Limbeek1
2. Atkinson, Ross A., Stephenson, John, Jones, Anna, Williamson, J. Bradley and Ousey, Karen (2013) Assessing compliance with a care bundle for surgical site infection in surgery for spinal metastases. In: Wounds UK Annual Conference 2013, 11th - 13th November 2013, Harrogate, UK. (Unpublished)
3. (SSI) Toolkit - Centers for Disease Control and Prevention
CachedSimilarStrategies to prevent surgical site infections in acute care hospitals. .... modifiable risk factor for surgical site infection after spinal surgery. .... SSI Bundles.
4. Surgical Site Infection - Institute for Healthcare Improvement
CachedSurgical site infection (SSI) continues to represent a significant portion of healthcare-associated infections because of their impact on morbidity, mortality, and ...