4 insights on practical strategies to reduce SSIs in spine surgery patients

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Surgical site infections have negative clinical and financial consequences. Mitigating these infections to protect patients and ASC bottom lines must be a priority for physicians and surgical care teams.

During a virtual session sponsored by 3M as part of Becker's 18th Annual Spine, Orthopedic and Pain Management-drive ASC + The Future of Spine Conference in June, a neurosurgeon and an anesthesiologist shared their perspectives on best practices to reduce SSIs. The presenters were:

  • Kyle Mueller, MD, department of neurosurgery, Brown University and Rhode Island Hospital in Providence
  • Richard C. Prielipp, MD, professor of anesthesiology, University of Minnesota in Minneapolis

Four insights:

  1. SSIs, which are common in spinal surgery, have serious consequences. Mueller stated the importance of reducing SSIs. "Many of these complications can have serious consequences, not only financially, but to the patient," he said. "In spine surgery with [SSIs] being very common, this is important for us to tackle."

  2. Physicians need to identify patients at highest risk for SSIs and take action to mitigate these risks. "When we look at spine surgery, one of the big things is we want to look at who is at risk [for SSIs]," Dr. Mueller said. He cited evidence showing that patient-associated risk factors include age, diabetes, obesity and having had preoperative radiation.

    Reducing these risks and preventing SSIs begins with preoperative planning and needs to be addressed in patient counseling. Also, physicians need to "look at the tools you are using pre, intra and postoperatively to reduce this risk," Dr. Mueller explained.

  3. From a surgeon's perspective, important strategies to reduce SSIs include skin preparation, antimicrobial drapes and use of negative pressure wound therapy. "Some form of skin prep is important in your management strategy in high-risk patients," Dr. Mueller said. He mentioned that studies show that DuraPrep™ is an effective skin prep. In addition to skin prep, many surgeons use an antimicrobial drape — such as 3M™ Ioban™ 2 Microbial Incise Drapes — to maintain sterility and reduce infection rates, especially for high-risk patients.

    An emerging strategy is closed incisional negative pressure wound therapy. NPWT optimizes the conditions around the incision, which enhances the ability to heal. NPWT has been used and proven effective in other specialties, where it has dramatically reduced infections and readmission rates. Dr. Mueller has used NPWT where appropriate and has seen an overall reduction in SSI rates. "Closed incisional negative pressure therapy is a powerful adjunct to optimizing high-risk surgical incisions," Dr. Mueller said. "It's very adaptable to surgeons' current workflow. And by reducing the surgical site infection and readmission rates in these high-risk patient populations, we will ultimately improve healthcare costs and the value in spine surgery."

  4. From an anesthesiologist's perspective, important strategies to reduce SSIs include smoking cessation, skin and nasal decontamination, temperature control and glucose management. Prielipp said there is no magic bullet for reducing SSIs and emphasized the need to "apply a constellation of efforts." Smoking cessation confers improved tissue oxygenation, which improves wound healing. Reducing the patient's microbial burden by decontaminating the skin and the nasal cavity can reduce infections; a Povidone-iodine solution from 3M proved effective at reducing infections and is a valid alternative to Mupirocin. Maintaining normal body temperature by using the 3M Bair Hugger™ Forced-Air Warming System reduces infections. And, use of drugs for hyperglycemia management is also an important strategy.

    "We discussed four important caveats to managing patients and minimizing the risk of surgical site infections with complex spine operations," Dr. Prielipp said. "Smoking cessation, skin and nasal decontamination, normothermia and glucose management are all key pillars to managing your patients."

To learn more about the event, click here.

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