Prevention of Surgical Site Infection after Spine Operation with Care Bundle

Abstract

Background: A Care Bundle is proposed to prevent surgical site infections (SSIs). This study investigated SSI incidence and risk factors at our hospital, developed an SSI prevention Care Bundle, and tested its efficacy. Methods: A retrospective review of 1,117 patients who underwent spinal surgical procedure under general anesthesia (January 2016-July 2023) was conducted. A total of 764 patients (mean age 69.7 y, 58.0% female) were included. SSI was diagnosed as per U.S. Centers for Disease Control and Prevention's guidelines. Risk factors evaluated included patient factors, operation-related factors, season, and Care Bundle implementation (introduced in April 2019). The Care Bundle included chlorhexidine gluconate bathing, skin disinfection, high-performance air purifier, glove changes, iodine-impregnated drapes, prophylactic antibiotic agents, and pre-operative sponge brushing. Results: SSI incidence was 2.6% (0.7% superficial, 1.9% deep), decreasing from 4.6% pre-Care Bundle to 1.0% post-implementation. Risk factors included smoking (p = 0.003), diabetes mellitus (p = 0.025), instrumentation (p = 0.039), posterior cervical operation (p = 0.049), and warm season (p = 0.024). Logistic regression identified Care Bundle implementation (odds ratio [OR] 0.27, p = 0.013), instrumentation (OR 3.59, p = 0.038), and warm season (OR 3.63, p = 0.025) as independent factors. Conclusion: The Care Bundle effectively reduced SSI. Certain factors such as instrumentation and surgical procedures during warm seasons were associated with greater SSI rates.

Keywords: Care Bundle; instrumentation; operation in warm season; posterior cervical spine operation; surgical site infection.