An International Survey to Understand Infection Control Practices for Spinal Cord Stimulation

David A Provenzano; Timothy Deer; Amy Luginbuhl Phelps; Zachary C Drennen; Simon Thomson; Salim M Hayek; Samer Narouze; Maunak V Rana; Tyler W Watson; Asokumar Buvanendran

doi:10.1111/ner.12356

An International Survey to Understand Infection Control Practices for Spinal Cord Stimulation

Neuromodulation. 2016 Jan;19(1):71-84. doi: 10.1111/ner.12356. Epub 2015 Oct 22.

Authors

Affiliations

¹ Pain Diagnostics and Interventional Care, Sewickley, PA, USA.
² The Center for Pain Relief, Inc., Charleston, WV, USA.
³ Economic and Finance Department at the AJ Palumbo Donahue School of Business, Duquesne University, Pittsburgh, PA, USA.
⁴ Basildon and Thurrock University Hospitals, Grays, Essex, UK.
⁵ University Hospitals Case Medical Center, Cleveland, OH, USA.
⁶ Center for Pain Medicine at Western Reserve Hospital, Cuyahoga Falls, OH, USA.
⁷ Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
⁸ Rush University Medical Center, Chicago, IL, USA.

PMID: 26490243
DOI: 10.1111/ner.12356

Abstract

Objectives: Surgical site infections (SSIs) are associated with significant healthcare costs and morbidity. Limited research exists specific to the prevention of spinal cord stimulation (SCS) SSIs. The objectives of this international survey were to examine current infection control practices for SCS trials and implants and to compare reported responses with evidence-based recommendations.

Materials and methods: A 33-question survey was developed based on an extensive literature review for infection control policies. The survey was hosted on the Internet. Dispersion of the survey occurred through professional associations and device manufacturers. Responses to 15 questions directly related to defined CDC, NICE, and SCIP evidence-based infection control practice recommendations were classified as either compliant or noncompliant. The survey was open for 20 days. Responses also were grouped and analyzed based on geographic location, practice location, and procedural volumes.

Results: Five hundred six physicians responded to the survey. Compliance rates for CDC, NICE, SCIP infection control practice recommendations were low with only four of the 15 questions having compliance rates ≥80%. Areas associated with high levels of noncompliance included weight-based antibiotic dosing, hair removal strategies, double gloving, surgical dressing, skin antiseptic agent selection, and postoperative continuation of antibiotics. Geographic and practice type variations existed for particular infection control practices. Procedural volume influenced operative implant times with low physician procedural volumes associated with extended operative times.

Conclusions: The survey provided significant insight into current practices and will assist in the development of specific SCS infection control policies. Based on the survey, further education is warranted on infection control strategies for physicians performing spinal cord stimulator trials and implants.

Keywords: Infection; infection control; spinal cord stimulation; surgical site infection.

MeSH terms

Adult
Anti-Bacterial Agents / therapeutic use
Female
Health Surveys*
Humans
Infection Control / methods*
International Cooperation*
Male
Spinal Cord Stimulation / adverse effects*
Surgical Wound Infection / prevention & control*

Substances

Anti-Bacterial Agents