Physician Awareness Combined With Perioperative Infection Prevention Bundles Results in Durable Neurosurgical Infection Control and Cost Savings.

Abstract

Previous studies have demonstrated that enhancing physician awareness of infection incidence and implementing standardized infection prevention bundles result in decreased surgical site infection (SSI) rates with associated cost savings after elective craniotomy, ventricular shunt, and spinal fusion surgery. In this study, we build upon previous short-term studies and assess the long-term durability and effectiveness of these interventions. At a single institution, faculty and residents were informed of their individual, independently adjudicated monthly infection incidence (for craniotomies, ventricular shunts, and spinal fusions) ranked against their peers. Standardized perioperative infection prevention protocols were also implemented. Infection incidence and associated cost savings were calculated during baseline and long-term intervention (7-year) periods. During the long-term intervention period, the combination of physician awareness and perioperative infection control measures resulted in a 33% decrease in SSI rate for spinal fusions, from 3.3% (69 infections/2108 procedures) to 2.2% (144 infections/6483 procedures) ( P = .007; 95% CI [0.002, 0.019]). Similar interventions led to a 27% long-term reduction in SSI rate for craniotomies, from 3.0% (85 infections/2878 procedures) to 2.2% (159 infections/7350 procedures) ( P = .019; 95% CI [0.001, 0.015]). For ventricular shunt procedures, SSI rate did not significantly change from 3.7% (47 infections/1259 procedures) to 4.1% (65 infections/1568 procedures) ( P = .58; 95% CI [-0.019, 0.01]). Annual estimated cost savings from prevention of craniotomy and spinal fusion SSIs were $251 875 and $96 800, respectively. Our findings demonstrate that enhancing physician awareness of infection incidence in conjunction with standardized perioperative infection prevention bundles yields enduring neurosurgical infection control and resultant cost savings.