Introduction: Postoperative wound infections are a significant cause of morbidity, with reported rates as high as 4.5% in spine surgery. In an effort to reduce postoperative infections, a "bundle" of infection reduction methods was introduced. The “bundle” includes: 1) patient chlorhexidine gluconate bath, 2) nasal staphylococcus aureus nasal screen and decolonization, 3) audits of OR personnel and techniques, 4) increased dose and preoperative administration of antibiotics within an hour of incision, 5) Administration of intra-wound vancomycin, at surgeon discretion, 6) early patient mobilization, and 7) post-operative wound checks. A retrospective cohort analysis (n=1908) was conducted to compare the infection and readmission rates.

Methods: All spine surgeries conducted in the 2012 and 2013 years, by 9 spine surgeons at a tertiary care center, were included in the data. Propensity matching was used to identify two sub cohorts, equivalent in baseline health measures (demographics, comorbidities, & surgical data) for analysis. Infection rate and readmissions were tracked using billing data.

Results: Preliminary analysis indicates a decrease in infection rate from 3.7% to 1.5% from 2012 to 2013. Readmissions decreased from ~12% to ~7%.

Conclusions: Bundled infection prevention methods can be effective in decreasing patient suffering and the overall cost of care.

Patient Care: The implementation of these methods decreased spine surgery infection rate, readmissions, and, thus, the total cost of care.

Learning Objectives: Session participants should be able to: 1) describe the methods used to decrease infection rate, 2) understand the impact on patient care and cost, and 3) implement a similar protocol at their institution.

References: Ryan, S. L., Sen, A., Staggers, K., Luerssen, T. G. & Jea, A. A standardized protocol to reduce pediatric spine surgery infection: a quality improvement initiative. J. Neurosurg. Pediatr. 14, 259–265 (2014). Martin, J. R. et al. Experience with intrawound vancomycin powder for posterior cervical fusion surgery. J. Neurosurg. Spine 22, 26–33 (2015). Radcliff, K. E. et al. What is new in the diagnosis and prevention of spine surgical site infections. The spine journal: official journal of the North American Spine Society 15, 336–347 (2015). Tomov, M., Mitsunaga, L., Durbin-Johnson, B., Nallur, D. & Roberto, R. Reducing Surgical Site Infection in Spinal Surgery with Betadine Irrigation and Intra-Wound Vancomycin Powder. Spine (Phila. Pa. 1976). (2015). doi:10.1097/BRS.0000000000000789 Kang, D. G., Holekamp, T. F., Wagner, S. C. & Lehman, R. A. J. Intrasite Vancomycin Powder for the Prevention of Surgical Site Infection in Spine Surgery: A Systematic Literature Review. The spine journal: official journal of the North American Spine Society (2015). doi:10.1016/j.spinee.2015.01.030