Implementation of a care bundle and evaluation of risk factors for surgical site infection in cranial neurosurgery

• Care bundles are an in-vogue measure to counter SSI.
• In our series an evidenced based care bundle had no impact.
• Whilst logical and attractive, the bundling of evidence is not always successful.

ObjectivesSurgical site infection [SSI] increases mortality, morbidity and length of hospital stay. Peri-operative ‘care bundles’ have reduced SSI in some fields of surgery. The aim of this study was to determine the impact of bundle compliance on SSI in patients undergoing a craniotomy.Patients and methodCohort study of patients [N = 1253] undergoing a craniotomy over 17 months at a single centre. SSI was defined as arising within 30 days of operation or 1 year where an implant(s) remains. ‘Bundle compliance’ required administration of antibiotics <60 min of induction, maintenance of intraoperative blood sugar (BM) <11 mmol and temperature at >36 °C. SSI incidence was compared between bundle compliant and non-compliant groups. Case mix adjustment was performed using binary logistic regression.ResultsOver the study period, 1253 procedures were carried out and 66 patients (5.3%) developed a SSI. The majority (38, 57.6%) of these cultured Staphyloccoccus species. Only the use of an implant was found to be an independent risk factor for SSI [AOR 2.5, p < 0.005, 95%CI 1.4, 4.3]. The use of the bundle did not reduce the occurrence of SSI.ConclusionsAn evidence-based bundle did not reduce SSI in this neurosurgical series. The use of an implant was an independent risk factor of its occurrence.