1210 - What's Going on Back There? A Neurosurgery Investigation

Session Description: Neurosurgical procedures, especially those involving the spine, can have a highly variable infection rate depending on the type of procedure. One paper suggests an infection rate as high as 18% for instrumented fusions. These patients are often complex with multiple risk factors, some of which are non-modifiable, and surgery is the last resort.

In 2021, Infection Prevention investigated an increase in surgical site infections post-neurosurgery cases detected on routine surveillance (positive microbiology and recent surgery) and patients returning for post-surgery drain placement for infection. Twenty-four patients were reviewed (15 fusions, 9 laminectomies) with 10 developing superficial infections, 9 deep/organ space infections and 5 not meeting criteria. The investigation continued into 2022 and an additional 15 cases were reviewed (9 fusions, 6 laminectomies) with 6 superficial infections, 5 deep/organ space infections and 4 not meeting criteria.

Infection Prevention formed a multidisciplinary team made up of Neurosurgery, Inpatient/Outpatient Nursing, and Surgical Service leaders to investigate and review opportunities for improvement. There was lack of standardization across the patient continuum including how patients were optimized for surgery, preoperative antibiotics, intraoperative practices and post-op care. A state hospital association roadmap on prevention of surgical site infections was the framework to review practices and observations were conducted in the operating room. Quality improvement tools were used to help organize the work and track ongoing progress. Interventions thus far have included standardization of skin prep, review of patient education, operating room and vendor education, and aligning post-op wound management. This session will describe the process for investigation, review of best practices, use of quality improvement tools, implemented interventions and outcomes.