Major articleRisk factors for surgical site infections after neurosurgery: A focus on the postoperative period
Section snippets
Materials and methods
We conducted a prospective cohort study of SSI among adult neurosurgical patients at the 694-bed, University Nord Hospital in Marseille (France). All patients undergoing neurosurgical procedure (brain or spine surgery) from January 1, 2009-December 31, 2010, were eligible for inclusion. We excluded patients already diagnosed with an SSI, patients with open skull fracture, and those for whom the follow-up was incomplete. A neurosurgeon and a member of the infection control team systematically
Results
A total of 949 neurosurgical patients were prospectively included during a 24-month period. Their age ranged from 18-90 years (mean ± SD, 55.9 ± 18 years); 533 (56.5%) of them were men. The procedures were divided into cranial surgery (n = 526; 55.4%) and spinal surgery (n = 423; 44.6%). The general combined SSI rate was 4.5% (43 SSIs), corresponding primarily to deep or organ-space SSI (n = 37; 86%). It was divided into 25 SSIs (4.7%) for cranial surgery and 18 SSIs (4.2%) for spinal surgery.
Discussion
In this study we observed a significant decrease of the SSI incidence rate during a 2-year surveillance period. Implementation of an active surveillance with quarterly feedback to the surgical staff may have contributed to it.13 As noted by Heipel et al, active surveillance by an infection control practitioner together with neurosurgeons may enhance significantly the sensitivity for detecting SSI.14 Moreover, in a French national-based surveillance program, the SSI rate decrease was associated
Conclusion
Effective infection control programs should include an adequate number of trained infection control staff and a system for sustained reporting of SSI rates to surgeons. Infection control measures during the postoperative period represent a window of opportunity to improve the management of neurosurgical patients and to decrease their incidence of SSI.
Acknowledgment
We thank Yves Seccia for his technical assistance.
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Conflicts of interest: None to report.
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These authors contributed equally to this work.