scholarly journals Intrawound Vancomycin Powder Decreases Staphylococcal Surgical Site Infections After Posterior Instrumented Spinal Arthrodesis

2015 ◽  
Vol 28 (10) ◽  
pp. E584-E589 ◽  
Author(s):  
Aaron Heller ◽  
Terence E. McIff ◽  
Sue-Min Lai ◽  
Douglas C. Burton
Keyword(s):  
Surgical Site Infections ◽  
Vancomycin Powder ◽  
Spinal Arthrodesis

scholarly journals The Use of Vancomycin Powder for Surgical Prophylaxis Following Craniotomy

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 754-758 ◽  
Author(s):  
Vinod Ravikumar ◽  
Allen L. Ho ◽  
Arjun V. Pendharkar ◽  
Eric S. Sussman ◽  
Kevin Kwong-hon Chow ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Cost Savings ◽  
Surgical Site Infections ◽  
Control Group ◽  
Infection Prophylaxis ◽  
Potential Cost Saving ◽  
Infection Rates ◽  
Surgical Prophylaxis ◽  
Potential Cost ◽  
Vancomycin Powder

Abstract BACKGROUND: Intrawound vancomycin powder has been studied extensively in spinal fusion surgeries and been found to reduce rates of surgical site infections (SSIs) significantly. Despite its success in spinal surgeries, topical vancomycin has not been extensively studied with respect to cranial neurosurgery. OBJECTIVE: To evaluate the efficacy of intrawound topical vancomycin for prevention of SSIs following open craniotomies. METHODS: We retrospectively analyzed a large series of 350 patients from 2011 to 2015 in a pre/postintervention study of use of topical vancomycin to reduce postoperative craniotomy infection rates. We had a preintervention control group of 225 patients and a postintervention group of 125 patients that received intrawound topical vancomycin. RESULTS: Our preintervention incidence of SSI was 2.2% and this was significantly reduced to 0% following introduction of topical vancomycin (P < .5). An ad hoc cost analysis suggested a cost savings of ${\$}$59 965 with the use of topical vancomycin for craniotomies. CONCLUSION: Our study found a significant reduction in SSI rates after introduction of topical vancomycin. Thus, this simple intervention should be considered in all open craniotomy patients as both infection prophylaxis and a potential cost saving intervention.

Reducing surgical site infections following craniotomy: examination of the use of topical vancomycin

2015 ◽  
Vol 123 (6) ◽  
pp. 1600-1604 ◽  
Author(s):  
Kalil G. Abdullah ◽  
Mark A. Attiah ◽  
Andrew S. Olsen ◽  
Andrew Richardson ◽  
Timothy H. Lucas
Keyword(s):  
Primary Outcome ◽  
Surgical Site Infections ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Time Interval ◽  
Infection Rates ◽  
Skin Flora ◽  
Vancomycin Powder ◽  
Subgaleal Space ◽  
Typical Skin

OBJECT Although the use of topical vancomycin has been shown to be safe and effective for reducing postoperative infection rates in patients after spine surgery, its use in cranial wounds has not been studied systematically. The authors hypothesized that topical vancomycin, applied in powder form directly to the subgaleal space during closure, would reduce cranial wound infection rates. METHODS A cohort of 150 consecutive patients who underwent craniotomy was studied retrospectively. Seventy-five patients received 1 g of vancomycin powder applied in the subgaleal space at the time of closure. This group was compared with 75 matched-control patients who were accrued over the same time interval and did not receive vancomycin. The primary outcome measure was the presence of surgical site infection within 3 months. Secondary outcome measures included tissue pH from a subgaleal drain and vancomycin levels from the subgaleal space and serum. RESULTS Vancomycin was associated with significantly fewer surgical site infections (1 of 75) than was standard antibiotic prophylaxis alone (5 of 75; p < 0.05). Cultures were positive for typical skin flora species. As expected, local measured vancomycin concentrations peaked immediately after surgery (mean ± SD 499 ± 37 μg/ml) and gradually decreased over 12 hours. Vancomycin in the circulating serum remained undetectable. Subgaleal topical vancomycin was associated with a lower incidence of surgical site infections after craniotomy. The authors attribute this reduction in the infection rate to local vancomycin concentrations well above the minimum inhibitory concentration for antimicrobial efficacy. CONCLUSIONS Topical vancomycin is safe and effective for reducing surgical site infections after craniotomy. These data support the need for a prospective randomized examination of topical vancomycin in the setting of cranial surgery.

scholarly journals Root cause analysis of epidural spinal cord stimulator implant infections with resolution after implementation of an improved protocol for surgical placement

2019 ◽  
Vol 20 (4) ◽  
pp. 185-190
Author(s):  
Forest W Arnold ◽  
Sarah Bishop ◽  
David Johnson ◽  
LaShawn Scott ◽  
Crystal Heishman ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Operating Room ◽  
Surgical Site Infections ◽  
Root Cause Analysis ◽  
Hospital Epidemiology ◽  
Cause Analysis ◽  
Root Cause ◽  
Cord Injury ◽  
Vancomycin Powder ◽  
To Receive

Background: Placing a spinal stimulator for the purpose of restoring paralysed function is a novel procedure; however, paralysis predisposes people to infection. Preventing surgical site infections is critical to benefit this population. Objective: The objective of this study was to review the root cause analysis of postoperative wound infections by a hospital epidemiology team following implantation of epidural spinal cord neurostimulators in patients with chronic spinal cord injury. Methods: A team was assembled to review the case of every individual who had been enrolled to receive a neurostimulator at the facility. A root cause analysis was performed evaluating five categories: the patient; equipment; facility/environment; procedure; and personnel. Findings: The root cause analysis included 11 patients. Two patients became infected. Three others dehisced their wound without becoming infected. All patients were given preoperative antibiotics on time. A mean of 17 personnel were in the operating room during surgery. Vancomycin powder was used in the patients who either dehisced their wound or became infected. Conclusions: The root cause analysis provides guidance for other institutions performing the same novel procedure. This analysis did not reveal a direct association, but did generate several areas for improvement including increasing pre-surgical screening, cleaning transient equipment (e.g., computer screens), limiting traffic in the operating room, using new sterile instruments for each stage of the procedure, not reopening the back incision, not applying vancomycin powder, and using an antimicrobial envelope for the stimulator.

Intrawound Vancomycin Powder Reduces Surgical Site Infections in Posterior Cervical Fusion

Spine ◽  
2013 ◽  
Vol 38 (14) ◽  
pp. 1183-1187 ◽  
Author(s):  
Cyrus Caroom ◽  
Jessica M. Tullar ◽  
E. Garrison Benton ◽  
Jason R. Jones ◽  
Christopher D. Chaput
Keyword(s):  
Surgical Site Infections ◽  
Cervical Fusion ◽  
Vancomycin Powder ◽  
Posterior Cervical Fusion

The Utility of Vancomycin Powder in Reducing Surgical Site Infections in Deep Brain Stimulation Surgery

2018 ◽  
Vol 15 (5) ◽  
pp. 584-588 ◽  
Author(s):  
Ryan B Kochanski ◽  
Pouya Nazari ◽  
Sepehr Sani
Keyword(s):  
Deep Brain Stimulation ◽  
Treatment Group ◽  
Brain Stimulation ◽  
Low Cost ◽  
Surgical Site Infections ◽  
Post Treatment ◽  
Direct Result ◽  
Vancomycin Powder ◽  
The Impact ◽  
Deep Brain

Abstract BACKGROUND The impact of vancomycin powder on reducing postoperative surgical site infections (SSIs) in spine surgery has been studied extensively and is considered standard of care at many institutions. More recently, vancomycin powder has been shown to reduce SSI in cranial neurosurgery; however, limited studies have been performed assessing its impact in reducing SSIs in deep brain stimulation (DBS) surgery. OBJECTIVE To investigate the use of vancomycin powder as an adjunct to the current antibiotic prophylaxis regimen in DBS surgery in a large cohort of patients. METHODS All patients undergoing DBS-lead implantation surgery and chest generator placement or exchange were analyzed prior to and after the implementation of intrawound vancomycin powder, and the impact on infection rate and any complications were subsequently examined. RESULTS From 2015 to 2017, a total of 419 consecutive patients (159 in the pretreatment group, 260 in the post-treatment group) were included in the study. The rate of SSI prior to implementation of intrawound vancomycin was 3.1% (n = 5), which was reduced to 0.38% (n = 1) in the post-treatment group. No complications were noted as a direct result of using vancomycin powder. CONCLUSION Given its relatively low cost and side effect profile, the use of vancomycin powder may be an effective adjunct in reducing the rate of SSI in DBS surgery.

A Care Bundle Intervention to Prevent Surgical Site Infections After a Craniotomy

2020 ◽  
Author(s):  
Emilio Jiménez-Martínez ◽  
Guillermo Cuervo ◽  
Jordi Carratalà ◽  
Ana Hornero ◽  
Pilar Ciercoles ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cox Regression ◽  
Surgical Site Infections ◽  
Care Bundle ◽  
Primary Study ◽  
Preventive Strategy ◽  
Propensity Score Model ◽  
Vancomycin Powder ◽  
Score Model ◽  
Control Study

Abstract Background Although surgical site infections after a craniotomy (SSI-CRANs) are a serious problem that involves significant morbidity and costs, information on their prevention is scarce. We aimed to determine whether the implementation of a care bundle was effective in preventing SSI-CRANs. Methods A historical control study was used to evaluate the care bundle, which included a preoperative shower with 4% chlorhexidine soap, appropriate hair removal, adequate preoperative systemic antibiotic prophylaxis, the administration of 1 g of vancomycin powder into the subgaleal space before closing, and a postoperative dressing of the incisional surgical wound with a sterile absorbent cover. Patients were divided into 2 groups: preintervention (January 2013 to December 2015) and intervention (January 2016 to December 2017). The primary study end point was the incidence of SSI-CRANs within 1 year postsurgery. Propensity score matching was performed, and differences between the 2 study periods were assessed using Cox regression models. Results A total of 595 and 422 patients were included in the preintervention and intervention periods, respectively. The incidence of SSI-CRANs was lower in the intervention period (15.3% vs 3.5%; P &lt; .001). Using a propensity score model, 421 pairs of patients were matched. The care bundle intervention was independently associated with a reduced incidence of SSI-CRANs (adjusted odds ratio, 0.23; 95% confidence interval, .13–.40; P &lt; .001). Conclusions The care bundle intervention was effective in reducing SSI-CRAN rates. The implementation of this multimodal preventive strategy should be considered in centers with high SSI-CRAN incidences.

scholarly journals Current Strategies in Prevention of Postoperative Infections in Spine Surgery

2019 ◽  
Vol 10 (2) ◽  
pp. 183-194 ◽  
Author(s):  
Kivanc Atesok ◽  
Efstathios Papavassiliou ◽  
Michael J. Heffernan ◽  
Danny Tunmire ◽  
Irina Sitnikov ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Surgical Site Infections ◽  
Supplemental Oxygen ◽  
Tight Glycemic Control ◽  
Infection Prophylaxis ◽  
Preventive Strategies ◽  
Level Of Evidence ◽  
Skin Preparation ◽  
Vancomycin Powder ◽  
High Level

Study Design:Narrative review.Objectives:Postoperative surgical site infections (SSIs) are among the most common acute complications in spine surgery and have a devastating impact on outcomes. They can lead to increased morbidity and mortality as well as greater economic burden. Hence, preventive strategies to reduce the rate of SSIs after spine surgery have become vitally important. The purpose of this article was to summarize and critically analyze the available evidence related to current strategies in the prevention of SSIs after spine surgery.Methods:A literature search utilizing Medline database was performed. Relevant studies from all the evidence levels have been included. Recommendations to decrease the risk of SSIs have been provided based on the results from studies with the highest level of evidence.Results:SSI prevention occurs at each phase of care including the preoperative, intraoperative, and postoperative periods. Meticulous patient selection, tight glycemic control in diabetics, smoking cessation, and screening/eradication of Staphylococcus aureus are some of the main preoperative patient-related preventive strategies. Currently used intraoperative measures include alcohol-based skin preparation, topical vancomycin powder, and betadine irrigation of the surgical site before closure. Postoperative infection prophylaxis can be performed by administration of silver-impregnated or vacuum dressings, extended intravenous antibiotics, and supplemental oxygen therapy.Conclusions:Although preventive strategies are already in use alone or in combination, further high-level research is required to prove their efficacy in reducing the rate of SSIs in spine surgery before evidence-based standard infection prophylaxis guidelines can be built.

Reduced Surgical Site Infections in Patients Undergoing Posterior Spinal Stabilization of Traumatic Injuries using Vancomycin Powder

2012 ◽  
Vol 12 (9) ◽  
pp. S28
Author(s):  
Kevin R. O'Neill ◽  
Jason G. Smith ◽  
Amir M. Abtahi ◽  
Kristin R. Archer ◽  
Dan M. Spengler ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Spinal Stabilization ◽  
Traumatic Injuries ◽  
Vancomycin Powder

scholarly journals Application of Intrawound Vancomycin Powder during Spine Surgery in a Patient with Dialysis-Dependent Renal Failure

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Jackson Kim ◽  
Shane M. Burke ◽  
Evan Qu ◽  
Steven W. Hwang ◽  
Ron I. Riesenburger
Keyword(s):  
Renal Failure ◽  
Surgical Site Infections ◽  
Systemic Absorption ◽  
Surgical Incision ◽  
Additional Protection ◽  
Vancomycin Powder ◽  
Postoperative Serum ◽  
Serum Vancomycin ◽  
Stage Renal Disease ◽  
End Stage

Surgical site infections (SSIs) after spinal surgery are a serious complication that can be minimized with prophylaxis. Vancomycin is a common agent used in the prevention of SSI. Given that vancomycin is renally cleared, its use requires careful observation in dialysis-dependent patients due to toxicity at supratherapeutic levels. Since minimum inhibitory concentrations (MICs) for vancomycin have increased due to the emergence of resistant pathogens, the use of vancomycin in such patients is further complicated. Local instillation of vancomycin powder is thought to provide additional protection against SSI and have lower systemic absorption. We present a patient with end-stage renal disease that developed progressively debilitating cervical spondylotic myelopathy necessitating multilevel laminectomy and instrumented fusion. Prior to closure, 1 gram of vancomycin powder was sprinkled into the surgical incision. Postoperative serum vancomycin levels were well below those associated with nephrotoxicity and ototoxicity. Based on this experience, we reviewed the relevant guidelines that were designed to prevent postoperative infections in such dialysis-dependent patients. Intrawound application of vancomycin may be a legitimate and safe option for SSI prophylaxis in patients with renal failure on dialysis.

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