Infectious Diseases Department, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.
Spanish Network for Research in Infectious Diseases, Instituto Carlos III, Madrid, Spain.
Clin Infect Dis. 2021 Dec 6;73(11):e3921-e3928. doi: 10.1093/cid/ciaa884.
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.
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.
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 < .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 < .001).
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.
尽管开颅术后手术部位感染（SSI-CRANs）是一个严重的问题，会导致显著的发病率和费用，但有关其预防的信息却很少。我们旨在确定护理包的实施是否能有效预防 SSI-CRANs。
采用历史对照研究评估护理包，包括术前用 4%洗必泰肥皂淋浴、适当的毛发去除、充分的术前全身抗生素预防、在关闭前将 1 克万古霉素粉末施用于皮下空间，以及术后用无菌吸收性覆盖物对切口手术伤口进行敷料。患者分为 2 组：干预前（2013 年 1 月至 2015 年 12 月）和干预组（2016 年 1 月至 2017 年 12 月）。主要研究终点是术后 1 年内 SSI-CRANs 的发生率。进行倾向评分匹配，使用 Cox 回归模型评估两个研究期之间的差异。
干预前和干预期分别纳入 595 例和 422 例患者。干预组 SSI-CRANs 的发生率较低（15.3%比 3.5%；P<0.001）。使用倾向评分模型，匹配了 421 对患者。护理包干预与 SSI-CRANs 发生率降低独立相关（调整优势比，0.23；95%置信区间，0.13-0.40；P<0.001）。
护理包干预可有效降低 SSI-CRAN 发生率。在 SSI-CRAN 发生率较高的中心，应考虑实施这种多模式预防策略。
