scholarly journals Standardizing preoperative preparation to reduce surgical site infections among pediatric neurosurgical patients

2017 ◽  
Vol 19 (4) ◽  
pp. 399-406 ◽  
Author(s):  
Joshua K. Schaffzin ◽  
Katherine Simon ◽  
Beverly L. Connelly ◽  
Francesco T. Mangano
Keyword(s):  
Surgical Site Infections ◽  
Pediatric Neurosurgery ◽  
Postoperative Management ◽  
Neurosurgical Procedure ◽  
Protocol Adherence ◽  
Protocol Development ◽  
Published Evidence ◽  
Neurosurgical Patients ◽  
Before And After ◽  
Prevention Protocol

OBJECTIVE Surgical site infections (SSIs) are costly to patients and the health care system. Pediatric neurosurgery SSI risk factors are not well defined. Intraoperative protocols have reduced, but have not eliminated, SSIs. The effect of preoperative intervention is unknown. Using quality improvement methods, a preoperative SSI prevention protocol for pediatric neurosurgical patients was implemented to assess its effect on SSI rate. METHODS Patients who underwent a scheduled neurosurgical procedure between January 2014 and December 2015 were included. Published evidence and provider consensus were used to guide preoperative protocol development. The Model for Improvement was used to test interventions. Intraoperative and postoperative management was not standardized or modified systematically. Staff, family, and overall adherence was measured as all-or-nothing. In addition, SSI rates among eligible procedures were measured before and after protocol implementation. RESULTS Within 4 months, overall protocol adherence increased from 51.3% to a sustained 85.7%. SSI rates decreased from 2.9 per 100 procedures preintervention to 0.62 infections postintervention (p = 0.003). An approximate 79% reduction in SSI risk was identified (risk ratio 0.21, 95% CI 0.08–0.56; p = 0.001). CONCLUSIONS Clinical staff and families successfully collaborated on a standardized preoperative protocol for pediatric neurosurgical patients. Standardization of the preoperative phase of care alone reduced SSI rates. Attention to the preoperative in addition to the intraoperative and postoperative phases of care may lead to further reduction in SSI rates.

Single-dose antibiotic prophylaxis compared with multiple-dose protocol in clean pediatric neurosurgical interventions: a nonrandomized, historically controlled equivalence trial

2021 ◽  
pp. 1-8
Author(s):  
Esmaeil Mohammadi ◽  
Sina Azadnajafabad ◽  
Mehrdad Goudarzi ◽  
Keyvan Tayebi Meybodi ◽  
Farideh Nejat ◽  
...  
Keyword(s):  
Single Dose ◽  
Multiple Dose ◽  
Antimicrobial Prophylaxis ◽  
Meta Analysis ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Pediatric Neurosurgery ◽  
Total Cohort ◽  
Neurosurgical Patients ◽  
Tertiary Center

OBJECTIVE Guidelines recommend antimicrobial prophylaxis (AMP) preoperatively for "clean" spinal and cranial surgeries, while dose and timing remain controversial. The use of multiple-dose AMP for such surgeries is under debate in the pediatric context. In this clinical study, the authors aimed to compare single-dose with multiple-dose prophylactic antibiotic usage in cranial and spinal neurosurgical interventions of pediatric patients. METHODS All neurosurgical patients aged 28 days to 18 years who underwent surgery at a single tertiary center were assessed. Three cohorts (noninstrumented clean spinal, noninstrumented cranial, and instrumented cranial interventions), each of which comprised two 50-patient arms (i.e., single-dose AMP and multiple-dose AMP), were included after propensity score–matched retrospective sampling and power analysis. Records were examined for surgical site infections. Using a previously published meta-analysis as the prior and 80% acceptance of equivalence (margin of OR 0.88–1.13), logistic regression was carried out for the total cohort and each subcohort and adjusted for etiology by consideration of multiple-dose AMP as reference. RESULTS The overall sample included 300 age- and sex-matched patients who were evenly distributed in 3 bi-arm cohorts. There was no statistical intercohort difference based on etiology or type of operation (p < 0.05). Equivalence analysis revealed nondiscriminating results for the total cohort (adjusted OR 0.65, 95% CI 0.27–1.57) and each of the subcohorts (noninstrumented clean spinal, adjusted OR 0.65, 95% CI 0.12–3.44; noninstrumented cranial, adjusted OR 0.52, 95% CI 0.14–2.73; and instrumented cranial, adjusted OR 0.68, 95% CI 0.13–3.31). CONCLUSIONS No significant benefit for multiple-dose compared with single-dose AMPs in any of the pediatric neurosurgery settings could be detected. Since unnecessary antibiotic use should be avoided as much as possible, it seems that usage of single-dose AMP is indicated.

The impact of a multimodel approach to designing a new orthopedic department

2020 ◽  
pp. 1-6
Author(s):  
Elad Keren ◽  
Abraham Borer ◽  
Lior Nesher ◽  
Tali Shafat ◽  
Rivka Yosipovich ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prevention Measures ◽  
Orthopedic Department ◽  
Before And After ◽  
The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

The postoperative management of pain from intracranial surgery in pediatric neurosurgical patients

2014 ◽  
Vol 24 (7) ◽  
pp. 724-733 ◽  
Author(s):  
Joanne E. Shay ◽  
Deepa Kattail ◽  
Athir Morad ◽  
Myron Yaster
Keyword(s):  
Postoperative Management ◽  
Intracranial Surgery ◽  
Neurosurgical Patients

Mental disorders that occur against the background of water-electrolyte disorders in patients with neoplasms of chiasmal-sellar region

2020 ◽  
pp. 38-56
Author(s):  
K. V. Koval ◽  
G. E. Chmutin ◽  
P. L. Kalinin ◽  
M. A. Kutin ◽  
V. V. Ivanov
Keyword(s):  
Mental Disorders ◽  
Postoperative Period ◽  
World Literature ◽  
Sellar Region ◽  
Electrolyte Disorders ◽  
Appropriate Treatment ◽  
Specific Category ◽  
Neurosurgical Patients ◽  
Before And After ◽  
Shed Light

The work is devoted to assessing the results of the analysis of world literature for a period of more than 50 years: it reflects the data on the nature of the occurrence of mental disorders developing in patients with tumors of the chiasmal-sellar region against the background of water-electrolyte disorders both before and after surgery. The presented data shed light on the occurrence of the variants of mental disorders in such a specific category of neurosurgical patients, which may allow the clinician to timely determine the appropriate treatment tactics and reduce the severity of complications in the postoperative period.

Venous thromboembolism: deep venous thrombosis and pulmonary embolism in a neurosurgical population

2011 ◽  
Vol 114 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Ahmad Khaldi ◽  
Naseem Helo ◽  
Michael J. Schneck ◽  
Thomas C. Origitano
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Lower Extremity ◽  
Linear Correlation ◽  
Pharmacological Prophylaxis ◽  
Neurosurgical Procedure ◽  
Dvt Prophylaxis ◽  
Subcutaneous Heparin ◽  
Neurosurgical Patients ◽  
Duration Of Surgery

Object Venous thromboembolism (VTE), a combination of deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and death in neurosurgical patients. This study evaluates 1) the risk of developing lower-extremity DVT following a neurosurgical procedure; 2) the timing of initiation of pharmacological DVT prophylaxis upon the occurrence of VTE; and 3) the relationship between DVT and PE as related to VTE prophylaxis in neurosurgical patients. Methods The records of all neurosurgical patients between January 2006 and December 2008 (2638 total) were reviewed for clinical documentation of VTE. As part of a quality improvement initiative, a subgroup of 1638 patients was studied during the implementation of pharmacological prophylaxis. A high-risk group of 555 neurosurgical patients in the intensive care unit underwent surveillance venous lower-extremity duplex ultrasonography studies twice weekly. All patients throughout the review received mechanical DVT prophylaxis. Pharmacological DVT prophylaxis, consisting of 5000 U of subcutaneous heparin twice daily (initially started within 48 hours of a neurosurgical procedure and subsequently within 24 hours of a procedure) was implemented in combination with mechanical prophylaxis. The DVT and PE rates were calculated for each group. Results In the surveillance group (555 patients), 84% of the DVTs occurred within 1 week and 92% within 2 weeks of a neurosurgical procedure. There was a linear correlation between the duration of surgery and DVT development. The use of subcutaneous heparin reduced the rate of DVT from 16% to 9% when medication was given at either 24 or 48 hours postoperatively, without any increase in hemorrhagic complications. In the overall group (2638 patients), there were 94 patients who exhibited clinical signs of a possible PE and therefore underwent spiral CT; 22 of these patients (0.8%) had radiological confirmation of PE. There was no correlation between the use of pharmacological prophylaxis at either time point and the occurrence of PE, despite a 43% reduction in the lower-extremity DVT rate with pharmacological intervention. Conclusions The majority of DVTs occurred within the first week after a neurosurgical procedure. There was a linear correlation between the duration of surgery and DVT occurrence. Use of early subcutaneous heparin (at either 24 or 48 hours) was associated with a 43% reduction of developing a lower-extremity DVT, without an increase in surgical site hemorrhage. There was no association of pharmacological prophylaxis with overall PE occurrence.

Fever in the Neurosurgical Patient

2019 ◽  
pp. 123-155
Author(s):  
Rakhshanda Akram ◽  
Crystal Benjamin ◽  
Linda Mwamuka ◽  
Katherine A. Belden
Keyword(s):  
Patient Population ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Acalculous Cholecystitis ◽  
Postoperative Fever ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients ◽  
Postoperative Meningitis ◽  
Tract Infections ◽  
The Cost

Postoperative fever falls under the category of nosocomial fever, not incubating at the time of surgery. Early postoperative fever is more likely to be a part of the cytokine-mediated physiologic response to surgery and does not always need an infectious workup. Other important noninfectious causes of postoperative fever in neurosurgical patients include dysautonomia and central fever, which are often diagnoses of exclusion after infectious etiologies have been ruled out. Infections in neurosurgical patients can be secondary to the surgical procedure, such as postoperative meningitis, cerebrospinal fluid shunt and drain infections, cranial or spinal epidural abscess, and osteomyelitis and surgical site infections. Other hospital-associated infections, such as nosocomial pneumonia, sinusitis, diarrhea, urinary tract infections, bloodstream infections, and acalculous cholecystitis, are other important causes to be considered as part of the infectious workup. Hyperthermia-induced brain injury is a significant concern in neurosurgical patient population. Therefore, careful management of fever in this patient population is imperative to improve patient outcomes and decrease the cost of medical care.

Perioperative antimicrobial prophylaxis in adult patients: The first multicenter clinical practice audit with intervention in Greek surgical departments

2020 ◽  
pp. 1-8
Author(s):  
Elisavet Chorafa ◽  
Elias Iosifidis ◽  
Sotirios Tsiodras ◽  
Athanasios Skoutelis ◽  
Eleni Kourkouni ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Antimicrobial Agents ◽  
Antimicrobial Prophylaxis ◽  
Surgical Site Infections ◽  
Audit And Feedback ◽  
Elective Surgical Procedures ◽  
Before And After ◽  
Greek Hospitals ◽  
Practice Audit ◽  
Perioperative Antimicrobial Prophylaxis

Abstract Objective: To audit clinical practice and implement an intervention to promote appropriate use of perioperative antimicrobial prophylaxis (PAP). Design: Prospective multicenter before-and-after study. Setting: This study was conducted in 7 surgical departments of 3 major Greek hospitals. Methods: Active PAP surveillance in adults undergoing elective surgical procedures was performed before and after implementation of a multimodal intervention. The surveillance monitored use of appropriate antimicrobial agent according to international and local guidelines, appropriate timing and duration of PAP, overall compliance with all 3 parameters and the occurrence of surgical site infections (SSIs). The intervention included education, audit, and feedback. Results: Overall, 1,447 patients were included: 768 before and 679 after intervention. Overall compliance increased from 28.2% to 43.9% (P = .001). Use of antimicrobial agents compliant to international guidelines increased from 89.6% to 96.3% (P = .001). In 4 of 7 departments, compliance with appropriate timing was already >90%; an increase from 44.3% to 73% (P = .001) and from 20.4% to 60% (P = .001), respectively, was achieved in 2 other departments, whereas a decrease from 64.1% to 10.9% (P = .001) was observed in 1 department. All but one department achieved a shorter PAP duration, and most achieved duration of ~2 days. SSIs significantly decreased from 6.9% to 4% (P = .026). After the intervention, it was 2.3 times more likely for appropriate antimicrobial use, 14.7 times more likely to administer an antimicrobial for the appropriate duration and 5.3 times more likely to administer an overall appropriate PAP. Conclusion: An intervention based on education, audit, and feedback can significantly contribute to improvement of appropriate PAP administration; further improvement in duration is needed.

The physiopathology of respiration in neurosurgical patients

1979 ◽  
Vol 50 (6) ◽  
pp. 699-714 ◽  
Author(s):  
Elizabeth A. M. Frost
Keyword(s):  
Spinal Cord Injuries ◽  
Pediatric Neurosurgery ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Regulation Of Respiration ◽  
Content Type ◽  
Neurosurgical Patients ◽  
Cord Injury ◽  
Injured Patients ◽  
Fine Print

✓ Regulation of respiration is summarized as to peripheral and central chemoreceptors, controllers of voluntary and automatic respiration, and stimulators (CO2, O2, and pH). The information that may be obtained from blood-gas analysis is reviewed and basic problems in acid-base imbalance described. Commonly employed respiratory patterns are discussed. Preoperative pulmonary assessment necessary in elective intracranial situations, spinal cord injuries, and pediatric neurosurgery is outlined. Some of the special problems of the patient with multiple trauma, including injury to the central nervous system are reviewed. Central and peripheral factors that cause respiratory difficulty in head-injured patients are tabulated, and an outline is given of diagnosis and therapy. There are many possible causes of intraoperative hypoxia and hypercarbia, and these complications with their prevention or treatment are examined. Criteria for extubation are established. Finally, postoperative pulmonary care in elective, emergency, and cord injury situations is discussed. The key to successful perioperative pulmonary care of the neurosurgical patient requires close cooperation between the neurosurgeon and anesthesiologist.

scholarly journals Management of Postoperative Neurosurgical Patients

2019 ◽  
Vol 06 (02) ◽  
pp. 080-086
Author(s):  
Nidhi B. Panda ◽  
Shalvi Mahajan ◽  
Rajeev Chauhan
Keyword(s):  
Postoperative Care ◽  
Fluid Management ◽  
Surgical Techniques ◽  
Postoperative Management ◽  
Therapeutic Interventions ◽  
Team Collaboration ◽  
Good Communication ◽  
Neurosurgical Patients ◽  
Special Subset ◽  
Unique Individual

AbstractNeurosurgical patients are a special subset of patients requiring postoperative care. Challenging neurosurgical disease processes, advanced surgical techniques, and unique individual patient requirements advocate the need for meticulous postoperative care to ensure safe transition toward recovery. Timely detection of systemic and neurological changes allows early diagnostic and therapeutic interventions. The mainstay of postoperative care revolves around airway, maintenance of hemodynamics, sedation, analgesia, nutrition, fluid management, and management of disease-specific complications. In addition to standard monitoring, multimodal neuromonitoring should be used in neurosurgical patients. Hence, four key elements in the postoperative management of neurosurgical patients involve profound insight, rapid response, good communication skills, and team collaboration.

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