9-step infection prevention bundle halves spine surgery SSIs

After a hospital instituted a nine-part infection prevention bundle for spine surgery, surgical site infections fell 50 percent, while case costs also fell, according to a study in JAMA Surgery.

Researchers compared SSI rates and cost per case for patients undergoing discectomy, decompression, augmentation or fusion of the spine both before and after the nine-part bundle was implemented.

The bundle included the following components:

  1. Screening for Staphylococcus aureus colonization and subsequent decolonization
  2. Patients bathing themselves with chlorhexidine gluconate
  3. Patients using chlorhexidine gluconate wipes
  4. Optimizing storage of operating room supplies
  5. Using a preoperative antibiotic administration algorithm
  6. Training staff on betadine scrub and paint
  7. Using vancomycin in the wound for instrumented cases
  8. Mobilizing the patient early after surgery
  9. Checking wounds at two and six weeks post-surgery

Implementation of the bundle was linked with a 50 percent decline in SSIs as well as an $866 cost reduction per case, which can translate to roughly an $880 million reduction nationally, given the national volume of spine surgery, the authors wrote.

"These data suggest that appropriate implementation of an infection prevention bundle can reduce unnecessary harm and expenditures, translating to a clear increase in value," the study concludes.

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