Faculty Collaboration Database

Care Bundle Approach to Minimizing Infection Rates after Neurosurgical Implants for Neuromodulation: A Single-Surgeon Experience. World Neurosurg 2019 Aug;128:e87-e97

Date

04/16/2019

Pubmed ID

30986582

Pubmed Central ID

PMC6790165

DOI

10.1016/j.wneu.2019.04.003

Scopus ID

2-s2.0-85065981324 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

INTRODUCTION: Implant-related infections carry a high morbidity. Infectious rates for neuromodulation implants range from 1% to 9% for deep brain stimulation (DBS), 0% to 10% for spinal cord stimulation (SCS) systems, and 3% to 15% for intrathecal (IT) pump systems. Meanwhile, studies of care bundles report infection rate reduction to 1.0% for SCS and 0.3% for cardiac implants. Herein, we evaluate the effectiveness of an infection prevention bundle (IPB) in minimizing infections after surgeries for neuromodulation implants.

METHODS: An IPB focused on preoperative checklists, screening questionnaires, methicillin-resistant and methicillin-sensitive Staphylococcus aureus decolonization, weight-based antibiotic prophylaxis, strict draping and surgical techniques, and wound care education was implemented in our functional neurosurgery division in April 2015. We retrospectively reviewed all surgeries for implantation or replacement of SCS, DBS, and IT pump system components from March 2013 to October 2017. The patients were divided into pre-IPB and post-IPB groups. All procedures were performed by a single surgeon. Each surgical site was considered a unique surgical case. Infection rates were calculated for pre-IPB and post-IPB groups.

RESULTS: A total of 688 patients underwent 1161 unique surgical procedures (222 DBS electrodes, 419 IPG, 203 SCS, 317 IT pumps) during the study period. There were 546 pre-IPB and 615 post-IPB surgical procedures. The pre-IPB infection rates were 0%, 1.3%, and 8.7% for SCS, DBS, and IT pumps, respectively. The post-IPB infection rates were 0%, 0.3%, and 1.8% for SCS, DBS, and IT pumps, respectively.

CONCLUSIONS: Implementation of a standardized IPB approach reduced the number of infections for all neuromodulation implants studied. This approach can be adopted within any specialty to potentially decrease the incidence of implant-related infections.

Author List

Arocho-Quinones EV, Huang CC, Ward BD, Pahapill PA

Authors

Elsa V. Arocho-Quinones MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin
Peter A. Pahapill MD, PhD Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
Antibiotic Prophylaxis
Carrier State
Deep Brain Stimulation
Female
Humans
Infusion Pumps, Implantable
Infusions, Spinal
Male
Middle Aged
Neurosurgical Procedures
Patient Care Bundles
Perioperative Care
Prosthesis Implantation
Prosthesis-Related Infections
Retrospective Studies
Spinal Cord Stimulation
Staphylococcal Infections
Surgical Drapes
Surgical Wound Infection