Interdisciplinary Infection Prevention and Control Bundle in Neurosurgical Patients: Results of a Prospective Cohort Study

Julia Koch; Selin Saydan; Frank Schwab; Aminaa Sanchin; Sonja Hansen; Andrej Trampuz; Donara Margaryan; Peter Vajkoczy; Julia Sophie Onken

doi:10.1227/neu.0000000000002507

Interdisciplinary Infection Prevention and Control Bundle in Neurosurgical Patients: Results of a Prospective Cohort Study

Neurosurgery. 2023 Oct 1;93(4):835-846. doi: 10.1227/neu.0000000000002507. Epub 2023 May 1.

Authors

Julia Koch¹, Selin Saydan², Frank Schwab², Aminaa Sanchin¹, Sonja Hansen², Andrej Trampuz³, Donara Margaryan³, Peter Vajkoczy¹, Julia Sophie Onken¹

Affiliations

¹ Department of Neurosurgery, Charite - Universitätsmedizin Berlin, Corporate Member of Freie Universitat Berlin, Humboldt-Universit;t zu Berlin, and Berlin Institute of Health, Berlin , Germany.
² Institute of Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
³ Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.

PMID: 37125801
DOI: 10.1227/neu.0000000000002507

Abstract

Background: Surgical site infections (SSIs) account for one of the most common causes of nosocomial infections. Bundle approaches for infection prevention and control do not capture the full complexity of neurosurgical interventions.

Objective: To study the efficacy of an interdisciplinary infection prevention and control bundle (IPCB) in neurosurgery.

Methods: This was a prospective, single-center, observational study, analyzing 3 periods: before (2014), during (2017), and after (2019) full implementation of IPCB. IPCB included the following infection prevention measures: preoperative decolonization, patient engagement, operating room (OR) hygiene protocol, and pre-, peri-, and postoperative standard operating procedures (SOPs) while infection control measures included intraoperative sonication, blood culture inoculation, and interdisciplinary SSI management. All neurosurgical patients being readmitted to the hospital for SSIs within 90 days after receiving index surgery were included in the trial (403/9305).

Results: Implementation of IPCB resulted in more frequently succeeded pathogen isolation in patients with SSI (2014: 138 isolates in 105 (83%) patients with SSI, 2017: 169 isolates in 124 (91%) patients with SSI, and 2019: 199 isolates in 136 (97%) patients with SSI; P < .001). Proportion of gram-positive SSI and virulence was declining ( P = .041, P = .007). The number of repeated revision surgeries decreased from 26 (20%) in 2014 and 31 (23%) in 2017 to 18 (13%) in 2019 ( P = .085). Significantly, fewer patients experienced sepsis in response to SSI (2014: 12%, 2017: 10%, and 2019: 3.6%, P = .035). In-hospital mortality rate was declining from 12 (9.4%) in 2014 to 9 (6.6%) in 2017 to 5 (3.6%) in 2019 ( P = .148).

Conclusion: Introducing an interdisciplinary IPCB in neurosurgery leads to a significant reduction of sepsis and decreased in-hospital mortality while a pathogen switch toward gram-negative bacteria was observed. Minimizing diagnostic gap of pathogen detection toward a more efficient anti-infective treatment may be the main reason for the substantial decrease in morbidity and mortality.

Publication types

Observational Study

MeSH terms

Anti-Infective Agents*
Humans
Neurosurgery*
Neurosurgical Procedures / adverse effects
Prospective Studies
Risk Factors
Sepsis*
Surgical Wound Infection / etiology
Surgical Wound Infection / prevention & control

Substances

Anti-Infective Agents