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Clin Neurol Neurosurg. 2016 May;144:121-5. doi: 10.1016/j.clineuro.2016.03.025. Epub 2016 Mar 29.

Implementation of a care bundle and evaluation of risk factors for surgical site infection in cranial neurosurgery.

Author information

1
Dept. of Neurosurgery, Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust (SRFT), Salford, UK. Electronic address: Benjamin.davies4@nhs.net.
2
Dept. of Neurosurgery, Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust (SRFT), Salford, UK.

Abstract

OBJECTIVES:

Surgical site infection [SSI] increases mortality, morbidity and length of hospital stay. Peri-operative 'care bundles' have reduced SSI in some fields of surgery. The aim of this study was to determine the impact of bundle compliance on SSI in patients undergoing a craniotomy.

PATIENTS AND METHOD:

Cohort study of patients [N=1253] undergoing a craniotomy over 17 months at a single centre. SSI was defined as arising within 30days of operation or 1year where an implant(s) remains. 'Bundle compliance' required administration of antibiotics <60min of induction, maintenance of intraoperative blood sugar (BM) <11mmol and temperature at >36°C. SSI incidence was compared between bundle compliant and non-compliant groups. Case mix adjustment was performed using binary logistic regression.

RESULTS:

Over the study period, 1253 procedures were carried out and 66 patients (5.3%) developed a SSI. The majority (38, 57.6%) of these cultured Staphyloccoccus species. Only the use of an implant was found to be an independent risk factor for SSI [AOR 2.5, p<0.005, 95%CI 1.4, 4.3]. The use of the bundle did not reduce the occurrence of SSI.

CONCLUSIONS:

An evidence-based bundle did not reduce SSI in this neurosurgical series. The use of an implant was an independent risk factor of its occurrence.

KEYWORDS:

Care bundle; Cranial neurosurgery; Risk factors; Surgical site infection

PMID:
27046291
DOI:
10.1016/j.clineuro.2016.03.025
[Indexed for MEDLINE]

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