A Closer Look at SSI Prevention Protocols
SSIs are one of the leading causes of spine surgery readmission (often with longer hospital stays) and post-operative morbidity.
The team’s goals were “To summarize the implant removal rate, common bacterial organisms found, time of onset, ratio of superficial to deep infection, and regurgitating the prevalence among all the retrospective and prospective studies on management and characterization of surgical site infections (SSIs).”
The most commonly detected source of SSI found by this study were methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermis, Staphylococcus aureus, Staphylococcus epidermis, and Propionibacterium acnes.
There are a number of implant handling methods which can prevent SSI including but not limited to, “keeping implants covered until the immediate time of use, reducing OR traffic, avoiding reprocessing of implants (i.e., providing sterile prepackaged single-use implants), and to avoid touching the implants altogether.”
“SSIs in medical care are deemed as ‘never events’ and their occurrence is considered to be influenced by the hospital policies and procedures. Such an outlook toward infection leads many practitioners and hospital system[s] to bundle as many potential measures and/or increase the intensity (dosage in some cases) of individual measures, some to the point of redundancy.”
Despite all prevention methods, SSIs still happen.
Furthermore, said Dr. Agrawal, implant reprocessing should stop, and intraoperative exposure should be minimized.
Four Surgeries and $1 Million per Patient, on Average
Agarwal and his colleagues noted that it is possible for postoperative patients to remain infection-free a month or even a year following surgery, but still develop an infection later.
Their August 2019 research study, “Implant Retention or Removal for Management of Surgical Site Infection After Spinal Surgery,” reported that although long-term antibiotics and continuous irrigation and debridement were common clinical responses, the majority of the research cites implant removal or replacement as the most critical factor in decreasing the risk of infection recurrence.
Post-operatively, infections are most commonly managed via irrigation, debridement, vacuum-assisted wound closure (VAC) or antibiotics administration (both intravenous and oral).
And, the research team found, studies consistently suggested implant removal to avoid recurrence of SSI. Many authors wrote that repeat site debridement was not effective so long as pedicular and/or interbody construct implants remained.
One study estimated that SSI treatment required an average of four surgeries for each patient, with the “average cost of SSI treatment range from a quarter of a million to just shy of a million dollars per patient.”
