Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-07T21:04:07.239Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Spinal Surgical Site Infection, Houston, Texas

Published online by Cambridge University Press:  02 January 2015

Kelley M. Boston ,
Sarah Baraniuk ,
Shana O'Heron  and
Kristy O. Murray
Kelley M. Boston
Affiliation:
University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas Infection Prevention and Management Associates, Houston, Texas
Sarah Baraniuk
Affiliation:
University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas
Shana O'Heron
Affiliation:
University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas Infection Prevention and Management Associates, Houston, Texas
Kristy O. Murray*
Affiliation:
University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas
*
University of Texas Health Science Center at Houston, Center for Infectious Diseases, School of Public Health, 1200 Herman Pressler, Room 334, Houston, TX 77030 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Because of an increase in the rate of surgical site infections (SSIs) following spinal procedures at the study hospital, we conducted a study to determine risk factors associated with the development of a SSI.

Design.

Case-control study.

Setting.

A community hospital in Houston, Texas, with more than 500 beds.

Patients.

Fifty-five case patients who developed SSI after spinal surgery and 179 control patients who did not develop SSI after spinal surgery.

Methods.

We examined patient- and hospital-associated risk factors for SSI by using existing data on patients who underwent spinal operations at the study hospital between December 2003 and August 2005. Multivariable analysis was conducted using logistic regression to determine significant risk factors associated with SSI.

Results.

The presence of comorbidities (odds ratio [OR], 3.15 [95% confidence interval (CI), 1.20-8.26]) and surgical duration greater than the population median of 100 minutes (OR, 2.48 [95% CI, 1.12-5.49]) were identified as independent risk factors for SSI. The use of only povidone-iodine for preoperative skin antisepsis was found to be protective (OR, 0.16 [95% CI, 0.06-0.45]). Specific operating room, hospital staff involved in the procedures, workers' compensation status, method of hair removal, smoking status, or incontinence were not statistically significant.

Conclusions.

The presence of comorbidities and increased surgical duration are risks for postoperative infection. The use of only povidone-iodine was found to decrease the risk of infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 9 , September 2009 , pp. 884 - 889
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Martone, WJ, Nichols, RL. Recognition, prevention, surveillance and management of surgical site infections: introduction to the problem and symposium interview. Clin Infect Dis 2001;33(Suppl 2):S67–S68.Google Scholar
2.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance System: Semiannual Report. Atlanta, GA: Centers for Disease Control and Prevention; 1996.Google Scholar
3.Dhillon, KS, Kok, CS. The incidence of post-operative wound infection in orthopaedic surgery. Med J Malaysia 1995;50:237–240.Google Scholar
4.Roy, MC, Perl, TM. Basics of surgical-site infection surveillance. Infect Control Hosp Epidemiol 1997;18:659–668.Google Scholar
5.Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical site infection in the 1990s: attributable mortality, excess length of hospitalization and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.Google Scholar
6.Bernard, B. Prevention of surgical site infections. Infect Control Today 2003;7:220–224.Google Scholar
7.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
8.Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:1659–1702.Google Scholar
9.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:247–278.Google Scholar
10.Sands, K, Vineyard, G, Platt, R. Surgical site infection occurring after hospital discharge. J Infect Dis 1996;173:963–970.Google Scholar
11.Delgado-Rodríguez, M, Medina-Cuadros, M, Gómez-Ortega, A, et al.Cholesterol and serum albumin levels as predictors of cross infection, death, and length of hospital stay. Arch Surg 2002;137:805–812.Google Scholar
12.Hosmer, DW, Lemeshow, S. Applied Logistic Regression. 5th ed. New York, NY: John Wiley & Sons; 2000.Google Scholar
13.White, J, Fry, D, Howard, R. Surgical site. In: Association for Professionals in Infection Control (APIC), eds. APIC Text of Infection Control and Epidemiology. Washington, DC: Association for Professionals in Infection Control; 2002.Google Scholar
14.Lilienfeld, DE, Vlahov, D, Tenney, JH, Mclaughlin, JS. Obesity and diabetes as risk factors for postoperative wound infections after cardiac surgery. Am J Infect Control 1988;16:3–6.Google Scholar
15.Wimmer, C, Gluch, H, Franzreb, M, Ogon, M. Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord Tech 1998;11:124–128.Google Scholar
16.Boyko, EJ, Lipsky, AB. Infection and Diabetes. In: National Diabetes Data Group. Diabetes in America. 2nd ed. NIH Publication No. 95-1468. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; 1995.Google Scholar
17.Terranova, A. The effects of diabetes mellitus on wound healing. Plast SurgNurs 1991;11:20–25.Google Scholar
18.Perry, JW, Montgomerie, JZ, Swank, S, Gilmore, DS, Maeder, K. Wound infections following spinal fusion with posterior segmental spinal instrumentation. Clin Infect Dis 1997;24:558–561.Google Scholar
19.Brook, I, Frazier, EH. Aerobic and anaerobic microbiology of wound infection following spinal fusion in children. Pediatr Neurosurg 2000;32:20–23.Google Scholar
20.Sorensen, LT, Karlsmark, T, Gottrup, F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 2003;238:1–5.Google Scholar
21.Kjønniksen, I, Andersen, BM, Sondenaa, VG, Segadal, L. Preoperative hair removal—a systematic literature review. AORN J 2002;75:928–938.Google Scholar
22.Bratzler, DW, Houck, PM, for the Surgical Infection Prevention Guidelines Writers Workgroup. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004;38:1706–1715.Google Scholar
23.Latham, R, Lancaster, AD, Covington, JF, Pirolo, JS, Thomas, CS Jr.The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol 2001;22:607–612.Google Scholar
24.Dellinger, EP. Preventing surgical site infections: the importance of timing and glucose control. Infect Control Hosp Epidemiol 2001;22:604–605.Google Scholar
25.Nichols, RL. Preventing surgical site infections: a surgeon's perspective. Emerg Infect Dis 2001;7:220–224.Google Scholar
26.American Institute of Architects. Guidelines for Design and Construction of Hospital and Health Care Facilities. Washington, DC: American Institute of Architects Press; 1996.Google Scholar