Standardized Improvements in Pre-Op Protocols Reduced Incidence of Neurosurgical Site Infections

Published April 19, 2017
Journal of Neurosurgery: Pediatrics

Some of the most crucial times in a neurosurgical procedure occur before the surgeon, or even the patient arrives. With surgical site infections (SSIs) costly to both patients and healthcare systems, improving preoperative protocols has become imperative.

“We found that standardizing SSI prevention outside of the OR, without changing anything done in the OR, significantly reduced SSIs,” says first author Joshua Schaffzin, MD, PhD, of the Division of Infectious Diseases. “The extent was larger than expected."

Researchers, led by senior author Francesco Mangano, DO, chief of Neurosurgery, studied an intervention in elective surgery procedures. They found that overall protocol adherence increased from 51.3 percent to a sustained 85.7 percent within just four months. SSI rates decreased from 2.9 per 100 procedures pre-intervention to 0.62 infections post-intervention.

The study revealed that the most common root-cause of SSI actually occurred in the patient’s home before surgery: improper bathing.

Before the study, family adherence to guidelines was inconsistent and untracked. The team reported that several factors that drive up family stress can contribute to non-adherence, including medical leave, missing work, arranging care for other children, and concerns about surgical risks. Better communication about surgery preparation, including printed materials and phone conversations, improved adherence.

Other outcomes from the project included improved communication between clinic nurses and pre-op nurses, more robust data compilation, and better pre-op care of the incision site.

“Most exciting about this type of research is working with people in real-time, with less control than basic science,” Schaffzin says. “While that causes some angst for investigators, it creates a unique opportunity for discovery.”