REDUCTION OF DEEP SPINAL SURGICAL INFECTION RATES BY OVER 50% AT THE NATIONAL TRAUMA SPINAL UNIT OF IRELAND

Abstract

Introduction: Definitions of surgical site infections are based on those of CDC, published in 1992. Infections that occur within 30 days of surgery are classified as:

1. Superficial – involves only the skin or subcutaneous tissue.

2. Deep – involves the deep tissues (i.e. fascial and muscle layers).

3. Organ / space – where part of the anatomy is manipulated during surgical procedure and within one year if an implant is in place.

Between 2006 and 2008 the infection rates of the National Spinal Surgery Unit have been closely monitored as part of a multidisciplinary team approach led in large part by the Infection Control Team. A surveillance protocol was developed. They prospectively monitored every spinal surgery patient as part of a infection control data base. Biographical and medical history data were collated including diabetic status, prophylactic antibiotic use and surgical procedure. Information was collated and feedback on changes was examined by audit which was conducted regularly.

Methods: As part of the routine audit of the NSSU department a deep infection rate of 3.5% was noted in 2006. The infection control team set up a specific unit to co ordinate surveillance of NSSU. We describe simple and evidence based protocols for prophylactic antibiotic use in conjunction with the Pharmacy, Infection Control and Microbiology department was organised in running with international standards. Furthermore, surgical, nursing and paramedical staff, involved in the NSSU, were swabbed routinely. New rigid guidelines were introduced in theatre for draping patients including the addition of topical alcohol use and 8 minute minimum bethidine drying time.

Results: From 2006, deep infection rate was 3.5%. This was followed by a 2.49% in 2007 and 1.79% in 2008. Of note the deep infection rate in 2004 was 5.5% (2 years prior to implementation of Infection Control protocols).

Conclusions: The National Spinal Surgery Unit was able to decrease the deep infection rate by 51% over 3 years by the implementation of careful prospective surveillance by a multidisciplinary team involving an Infection Control team which monitored the NSSU prospectively as well as co-ordinating changes in the protocol of antibiotic use as well peri-operative sterile techniques. We describe simple protocols which can be easily used in other institutions to aid in the mitigation of deep spinal surgical infection.