1250. Don’t Turn Your Back on Fusion Surgical Site Infections (SSIs)

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BackgroundSpinal fusion surgical site infections (SSI) increase morbidity, length of stay, readmissions and cost compared with those who do not develop an SSI. Initiatives aimed at improving spinal fusion care and reducing SSI are essential.MethodsIn a large metropolitan teaching hospital that performs 1,352 fusions annually, a multidisciplinary team consisting of infection prevention (IP), neurosurgeons, a performance improvement specialist, administration, and postoperative nursing staff was convened to discuss fusion SSI prevention best practices. The SSI prevention team focused on improving chlorhexidine (CHG) bathing compliance in preoperative areas and appropriate alcohol containing skin preparation compliance, developing a postoperative power plan, implementing CHG bathing postoperatively and standardizing postoperative wound care. Compliance with CHG bathing and alcohol containing skin prep was monitored, dressing audits were completed and compliance with all process measures was fed back to the stakeholders. Rates of fusion SSI pre-intervention (January 2017 thru June 2018) were compared with postintervention (July thru December 2018)ResultsFrom July 2018 to December 2018, compliance with CHG bathing in the preoperative area increased from 81% to 92% and compliance with the use of alcohol containing skin preparation agent improved from 83% to 94%. Postoperative daily CHG bath x 10 days was implemented January 2018 with 72% compliance. With the efforts of the multidisciplinary team, Fusion SSI decreased from 1.43 to 0.75 per 100 fusion surgeries (Risk Ratio 0.52, 95% CI 0.18 -1.27, p-value 0.17) pre vs. post-intervention. This correlated to a Standardized Infection Ratio (SIR) decrease from 1.43 to 0.73. There was a concomitant trend toward decreased observed: expected (O: E) 30-day readmission (1.05 pre vs. 0.98 post) during the same time frame.ConclusionAn interdisciplinary team developed spinal fusion bundle consisting of CHG bathing pre and postoperatively, alcohol containing skin preparation agent, and standardized postoperative dressing care resulted in a trend toward decreased fusion SSIs. Further data are needed to determine whether the improvement in process measures and outcomes is sustainable and significant.Disclosures All authors: No reported disclosures.