Provenzano David A, Deer Timothy, Luginbuhl Phelps Amy, Drennen Zachary C, Thomson Simon, Hayek Salim M, Narouze Samer, Rana Maunak V, Watson Tyler W, Buvanendran Asokumar
Pain Diagnostics and Interventional Care, Sewickley, PA, USA.
The Center for Pain Relief, Inc., Charleston, WV, USA.
Neuromodulation. 2016 Jan;19(1):71-84. doi: 10.1111/ner.12356. Epub 2015 Oct 22.
Surgical site infections (SSIs) are associated with significant healthcare costs and morbidity. Limited research exists specific to the prevention of spinal cord stimulation (SCS) SSIs. The objectives of this international survey were to examine current infection control practices for SCS trials and implants and to compare reported responses with evidence-based recommendations.
A 33-question survey was developed based on an extensive literature review for infection control policies. The survey was hosted on the Internet. Dispersion of the survey occurred through professional associations and device manufacturers. Responses to 15 questions directly related to defined CDC, NICE, and SCIP evidence-based infection control practice recommendations were classified as either compliant or noncompliant. The survey was open for 20 days. Responses also were grouped and analyzed based on geographic location, practice location, and procedural volumes.
Five hundred six physicians responded to the survey. Compliance rates for CDC, NICE, SCIP infection control practice recommendations were low with only four of the 15 questions having compliance rates ≥80%. Areas associated with high levels of noncompliance included weight-based antibiotic dosing, hair removal strategies, double gloving, surgical dressing, skin antiseptic agent selection, and postoperative continuation of antibiotics. Geographic and practice type variations existed for particular infection control practices. Procedural volume influenced operative implant times with low physician procedural volumes associated with extended operative times.
The survey provided significant insight into current practices and will assist in the development of specific SCS infection control policies. Based on the survey, further education is warranted on infection control strategies for physicians performing spinal cord stimulator trials and implants.
手术部位感染（SSIs）会带来高昂的医疗成本并引发并发症。针对预防脊髓刺激（SCS）相关手术部位感染的研究有限。这项国际调查的目的是审视当前脊髓刺激试验及植入手术的感染控制措施，并将报告的回复与循证建议进行比较。
基于对感染控制政策的广泛文献综述，设计了一份包含33个问题的调查问卷。该问卷通过互联网发布。通过专业协会和设备制造商进行问卷分发。对与美国疾病控制与预防中心（CDC）、英国国家卫生与临床优化研究所（NICE）以及外科感染预防（SCIP）循证感染控制实践建议直接相关的15个问题的回复，被归类为符合或不符合。调查为期20天。回复还根据地理位置、执业地点和手术量进行了分组与分析。
506名医生回复了该调查。CDC、NICE、SCIP感染控制实践建议的符合率较低，15个问题中只有4个的符合率≥80%。不符合率较高的方面包括基于体重的抗生素给药、毛发去除策略、双层手套使用、手术敷料、皮肤消毒剂选择以及术后抗生素的持续使用。特定感染控制措施存在地理和执业类型差异。手术量影响手术植入时间，医生手术量低与手术时间延长相关。
该调查为当前实践提供了重要见解，并将有助于制定特定的脊髓刺激感染控制政策。基于该调查，有必要对进行脊髓刺激器试验和植入手术的医生开展感染控制策略方面的进一步教育。
