Antibiotic prophylaxis in spine surgery: a comparison of single-dose and 72-hour protocols.

BACKGROUND: Despite the general consensus on the use of single-dose antimicrobial prophylaxis (AMP) in instrumented spine surgery, evidence supporting this approach is not robust. AIM: To compare the efficacies of single-dose and 72 h AMP protocols for the prevention of surgical site infection (SSI) in instrumented spine surgery (ISS) in a before-and-after study. METHODS: Prospective non-randomized cohort study on 5208 patients who underwent spine surgery in one neurosurgical department between 2003 and 2014. Two protocols of AMP were compared in ISS: a single-dose protocol from 2003 to 2008, and a 72 h protocol from 2009 to 2014. Patients undergoing non-instrumented spine surgery (NSS) received single-dose prophylaxis throughout both periods. The outcome measure was the incidence of SSI. FINDINGS: For ISS, the SSI incidences were 5.3% for the single-dose protocol and 2.2% for the 72 h protocol (P < 0.01). For NSS, the SSI incidence was 0.8% between 2003 and 2008 and 1.2% between 2009 and 2014 (P = 0.054). Multiple correspondence analysis showed that in surgeries with an implant a one-dose prophylaxis carries a 7.1% risk of SSI; patients who received 72 h prophylaxis had a lower (3.6%) risk of SSI. CONCLUSION: Analysis of individual categories of data suggests that 72 h prophylaxis was the most important factor for minimizing the risk of wound infection in our study group.

Nail microbial colonization following hand disinfection: a qualitative pilot study.

Effective hand hygiene among healthcare workers is one of the basic principles of preventing nosocomial infections. The aim of the study was a qualitative examination of microbial colonization of nails following hand hygiene. The results were stratified by nail length: short versus long and the presence of a varnish coating: natural versus varnished. The presence of potentially pathogenic micro-organisms was correlated with nail length (odds ratio: 7.1; 95% confidence interval: 1.83-27.39; P < 0.001) and the presence of ultraviolet (UV)-cured nail polish (7.2; 1.25-40.91; P < 0.05). There is a high probability of ineffective hand hygiene when keeping long nails and when UV-cured nail polish is present on them.