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Cranial Surgical Site Infection Interventions and Prevention Bundles: A Systematic Review of the Literature.
Mann, Michael; Wright, Christina Huang; Jella, Tarun; Labak, Collin M; Shammassian, Berje; Srivatsa, Shaarada; Wright, James; Engineer, Lilly; Sajatovic, Martha; Selman, Warren.
Afiliação
  • Mann M; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Wright CH; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Electronic address: christina.lee.huang@gmail.com.
  • Jella T; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Labak CM; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Shammassian B; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Srivatsa S; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Wright J; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Engineer L; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Sajatovic M; Department of Neurology, and Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Neurological and Behavioral Outcomes Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Selman W; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
World Neurosurg ; 148: 206-219.e4, 2021 04.
Article em En | MEDLINE | ID: mdl-33412319
ABSTRACT

BACKGROUND:

Cranial surgical site infections (cSSIs) are associated with significant morbidity. Measures to reduce cSSI are necessary to reduce patient morbidity as well as hospital costs and resource utilization.

OBJECTIVE:

To identify and characterize interventions or bundled interventions aimed at reduction of the incidence of cranial surgical site infections.

METHODS:

A systematic review of the literature was conducted according to the PRISMA guidelines. The search strategy included randomized trials, quasi-experimental studies, cohort studies, and case series published between 2000 and 2020 that evaluated interventions implemented to reduce cSSI. Bias assessments and data extraction were performed on included studies.

RESULTS:

The initial search generated 1249 studies. Application of inclusion and exclusion criteria and review of references yielded 15 single-intervention and 6 bundled-intervention studies. The single interventions included handwashing protocols, use of vancomycin powder, hair washing and clipping practices, and incision closure techniques. Bundled interventions addressed a variety of preoperative, intraoperative, and postoperative changes. Despite a lack of strong evidence to support the adoption of statistically significant interventions, the use of vancomycin powder may be effective in reducing cSSI. In addition, bundled interventions that involved cultural changes, such as increased teaching/education, personal accountability, direct observation, and feedback, showed some success in decreasing SSI rates.

CONCLUSIONS:

The strength of the conclusions is limited by small sample sizes, study heterogeneity, relatively low cSSI incidence, and high case variability. Some evidence supports the use of intraoperative vancomycin powder in adult noncranioplasty cases and the application of accountability, teaching, and surveillance of faculty, particularly those early in training.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Crânio / Infecção da Ferida Cirúrgica / Procedimentos Neurocirúrgicos Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Crânio / Infecção da Ferida Cirúrgica / Procedimentos Neurocirúrgicos Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article