Reduction of Surgical-site Infections in Neurosurgery – The Advantage of Antiseptics Combined with a Sterile Surface

Abstract

Surgical-site infections remain a significant contributor to hospital-acquired infections despite continued efforts to reduce their occurrence. Infection at the operative site is associated with high morbidity, mortality and prolonged hospitalisation. Typically, in neurosurgical cases the infection rate varies between 1 and 4%. The rise in antimicrobial resistance makes pre-operative methods to reduce surgical-site infection even more important. This is essential since hospitalised patients tend to have a higher frequency of resistant organisms, and the rise in methicillin-resistantStaphylococcus aureus(MRSA) infections has made antibiotic prophylaxis of this highly virulent organism more difficult. In this article we consider the role of pre-operative antisepsis, which aims to reduce bacterial density in the operative site, and the development of a sterile surface concept as part of an approach to reduce surgical-site infection in a neurosurgical setting. The risk of surgical-site infection is proportional to residual bacteria at the wound site, so a reduction in skin bacterial density will be associated with a concomitant reduction in surgical-site infection. The cumulativein vitroandin vivoevidence related to wound contamination and extensive clinical experience with implanted neurosurgical devices illustrate the utility of using 3M™Ioban™2 as part of an infection prevention regimen within neurosurgery.