Multifaceted infection prevention protocol is associated with reduced surgical site infection after spinal fusion: a before-and-after study.

Abstract

Surgical site infection (SSI) after spinal instrumentation surgery is a serious complication with substantial clinical and economic consequences, and evidence on multifaceted prevention protocols in spine surgery remains limited. To evaluate the effectiveness of a multifaceted SSI prevention protocol after spinal fusion surgery. Retrospective single-center before-and-after intervention study. A total of 631 consecutive patients who underwent spinal instrumentation surgery (NHSN procedure code FUSN) between April 2023 and October 2024 (pre-intervention, n=377; post-intervention, n=254). Incidence of SSI within 3 months after surgery, defined according to the CDC/NHSN surveillance criteria. The protocol, implemented in December 2023, comprised (1) universal preoperative povidone-iodine nasal decolonization, (2) chlorhexidine gluconate bathing, (3) enhanced perioperative glycemic control, and (4) reinforced intraoperative aseptic techniques. Demographics, surgical variables, and SSI rates were compared between groups, and multivariate logistic regression was performed. The SSI rate decreased from 2.9% (11/377) to 0.4% (1/254) after implementation (absolute risk reduction 2.5%, 95% CI 0.7-4.4%; p=0.033). Groups were comparable in sex, body mass index, smoking status, normothermia, ASA classification, operative time, NNIS risk index, and number of fused levels, although the post-intervention group was younger (median 65.5 vs 68 years; p=0.006). The protocol was an independent protective factor against SSI (Firth-penalized adjusted odds ratio 0.18; 95% CI 0.02-0.76; p=0.017). A multifaceted SSI prevention protocol was associated with a significant reduction in SSI after spinal instrumentation surgery, supporting the adoption of standardized, multi-target prevention strategies.