Arnold Forest W, Bishop Sarah, Johnson David, Scott LaShawn, Heishman Crystal, Oppy Leah, Ball Tyler, Sharma Mayur, Angeli Claudia, Ferreira Christie, Chen Yangsheng, Harkema Susan, Boakye Maxwell
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, USA.
Infection Prevention and Control Department, University of Louisville Hospital, Louisville, KY, USA.
J Infect Prev. 2019 Jul;20(4):185-190. doi: 10.1177/1757177419844323. Epub 2019 May 2.
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.
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.
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.
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.
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.
植入脊髓刺激器以恢复瘫痪功能是一种新的手术方法；然而，瘫痪会使人更容易感染。预防手术部位感染对于使这一人群受益至关重要。
本研究的目的是回顾医院感染控制团队对慢性脊髓损伤患者植入硬膜外脊髓神经刺激器后手术伤口感染的根本原因分析。
组建了一个团队来审查在该机构接受神经刺激器植入的每一位患者的病例。进行了根本原因分析，评估五个类别：患者；设备；设施/环境；手术过程；以及人员。
根本原因分析纳入了11例患者。2例患者发生感染。另外3例患者伤口裂开但未发生感染。所有患者均按时接受了术前抗生素治疗。手术期间手术室平均有17名人员。伤口裂开或发生感染的患者使用了万古霉素粉末。
根本原因分析为其他开展相同新手术的机构提供了指导。该分析未揭示直接关联，但确实产生了几个需要改进的方面，包括加强术前筛查、清洁临时设备（如电脑屏幕）、限制手术室人员流动、在手术的每个阶段使用新的无菌器械、不重新打开背部切口、不使用万古霉素粉末以及对刺激器使用抗菌封套。
