Spine surgeons must take all possible measures to decrease infection rates among their patients and produce the best outcomes. Infections can occur for various reasons and when an infection does occur, it takes more time and effort from the patient and the surgeon to resolve, which may or may not be reimbursed. "If you're not meticulous with sterile technique, you can get in trouble," says Donald Corenman, MD, of The Steadman Clinic in Vail, Colo. "Prevention is absolutely key because dealing with infections is a tremendous amount of work and it really sets the patient back."
Here are seven ways spine surgeons can decrease the risk of infection in their practice.
1. Strict patient selection. Infection rates are usually higher when procedures are performed at university and teaching hospitals because patients are generally sicker when undergoing surgery there, says Dr. Corenman. Be aware of the patient's chronic conditions, such as autoimmune deficiencies ore diabetes, and take the appropriate precautions against infections. "If a patient is chronically ill, work extra hard with the primary care physician to make sure the patient is ready for the procedure," says David McKalip, MD, a neurosurgeon practicing in St. Petersburg, Fla. The surgeon can also consider different types of operations for chronically ill patients, such as choosing an anterior instead of posterior procedure for a diabetic patient.
2. Screen for infections. Whenever possible, spine surgeons should only allow patients to undergo surgery if they are free of infection. "Insist that all cultures are negative 2-4 weeks preceding the surgery," says Dr. McKalip. This includes screening all infections, such as bladder or kidney infections, and taking blood cell counts. Naturally, if the patient needs emergency surgery, these measures cannot be taken and surgeons must rely on other precautions. "If the patient isn't the best candidate for surgery, you have to do everything you can to prevent their risk for infection," says Dr. Corenman.
3. Limit the number of people in the OR. Don't allow extra people, such as students or device company representatives, in the operating room unless it is absolutely necessary, says Dr. Corenmen. Even though students and representatives understand that certain areas of the operating room are sterile, they are undereducated and might not completely understand sterile technique. "There are areas around the patient that should be bacteria-free," says Dr. Corenman. "But if someone brushes against a bacteria area and then handles the instruments, they can spread infections that way."
4. Administer pre-op and post-op antiseptics. While some studies recommend against using antiseptics, other studies and physicians strongly promote their use to decrease the risk of infection during surgery. Antiseptics should be administered one hour before surgery and continued for three days after surgery, says Dr. McKalip. Surgeons can also advise that the patient take antibiotics in certain situations after the operation, such as before receiving dental work, says Dr. Corenman.
5. Take precautions during post-op period. Making sure to employ good wound care after the surgery is essential for further decreasing the rate of infections in spine surgery patients. Inflammation in the wound indicates there might be a problem which should be addressed immediately. The patients should be monitored closely when surgeons use dissolvable sutures to make sure there is no inflammation.
6. Follow the Halstead's principles. Spine surgeons should be familiar with the Hallstead principles for preventing infection and they should be careful to implement the principles during every surgery, says Dr. McKalip. These principles include good haemostasis, eliminate deadspace, anatomic dissection of tissues, use non-irritating suture material, avoidance of tension and strict asepsis during procedure preparation.
7. Trust the sterilization department. Whether the physician is working through a hospital or ambulatory surgery center, the spine surgeons must ensure the facility has a good sterile processing department, says Dr. Corenman. Surgeons need to make sure everyone around them is taking steps to prevent infection. "There is a whole laundry list of stuff you have to get after. You have to make sure your staff is on the same page," says Dr. Corenman. Surgeons should communicate with their staff and sterilization department for the best results. "It helps if the OR staff does a pre-cleaning process by spraying down the instrumentation with an enzyme spray," says Jerzy Kaczor, BSBA, MBA, a sterile processing consultant with Soyring Consulting. The spray will begin breaking down the enzymes and make the sterilization process easier.
The sterilization staff should also be familiar with the assembly trays and know which pieces of equipment might need special treatment, says Mr. Kaczor. Some spine instrumentation is delicate and can break if another instrument is on put top of it during sterilization. All the equipment for a tray should be kept together in facilities dealing with sterilization for multiple spine trays at once. "The department should have a set list of each item and a description of the instrumentation to tell you what goes in each specific tray," says Mr. Kaczor. "Keeping the trays together is more efficient because after sterilization you don't have to go through looking for specific items."
Read more about spine surgery:
- 10 Articles for Spine Practice Management
- Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
- 6 Ways to Avoid Denied Claims for Spine Procedures
Here are seven ways spine surgeons can decrease the risk of infection in their practice.
1. Strict patient selection. Infection rates are usually higher when procedures are performed at university and teaching hospitals because patients are generally sicker when undergoing surgery there, says Dr. Corenman. Be aware of the patient's chronic conditions, such as autoimmune deficiencies ore diabetes, and take the appropriate precautions against infections. "If a patient is chronically ill, work extra hard with the primary care physician to make sure the patient is ready for the procedure," says David McKalip, MD, a neurosurgeon practicing in St. Petersburg, Fla. The surgeon can also consider different types of operations for chronically ill patients, such as choosing an anterior instead of posterior procedure for a diabetic patient.
2. Screen for infections. Whenever possible, spine surgeons should only allow patients to undergo surgery if they are free of infection. "Insist that all cultures are negative 2-4 weeks preceding the surgery," says Dr. McKalip. This includes screening all infections, such as bladder or kidney infections, and taking blood cell counts. Naturally, if the patient needs emergency surgery, these measures cannot be taken and surgeons must rely on other precautions. "If the patient isn't the best candidate for surgery, you have to do everything you can to prevent their risk for infection," says Dr. Corenman.
3. Limit the number of people in the OR. Don't allow extra people, such as students or device company representatives, in the operating room unless it is absolutely necessary, says Dr. Corenmen. Even though students and representatives understand that certain areas of the operating room are sterile, they are undereducated and might not completely understand sterile technique. "There are areas around the patient that should be bacteria-free," says Dr. Corenman. "But if someone brushes against a bacteria area and then handles the instruments, they can spread infections that way."
4. Administer pre-op and post-op antiseptics. While some studies recommend against using antiseptics, other studies and physicians strongly promote their use to decrease the risk of infection during surgery. Antiseptics should be administered one hour before surgery and continued for three days after surgery, says Dr. McKalip. Surgeons can also advise that the patient take antibiotics in certain situations after the operation, such as before receiving dental work, says Dr. Corenman.
5. Take precautions during post-op period. Making sure to employ good wound care after the surgery is essential for further decreasing the rate of infections in spine surgery patients. Inflammation in the wound indicates there might be a problem which should be addressed immediately. The patients should be monitored closely when surgeons use dissolvable sutures to make sure there is no inflammation.
6. Follow the Halstead's principles. Spine surgeons should be familiar with the Hallstead principles for preventing infection and they should be careful to implement the principles during every surgery, says Dr. McKalip. These principles include good haemostasis, eliminate deadspace, anatomic dissection of tissues, use non-irritating suture material, avoidance of tension and strict asepsis during procedure preparation.
7. Trust the sterilization department. Whether the physician is working through a hospital or ambulatory surgery center, the spine surgeons must ensure the facility has a good sterile processing department, says Dr. Corenman. Surgeons need to make sure everyone around them is taking steps to prevent infection. "There is a whole laundry list of stuff you have to get after. You have to make sure your staff is on the same page," says Dr. Corenman. Surgeons should communicate with their staff and sterilization department for the best results. "It helps if the OR staff does a pre-cleaning process by spraying down the instrumentation with an enzyme spray," says Jerzy Kaczor, BSBA, MBA, a sterile processing consultant with Soyring Consulting. The spray will begin breaking down the enzymes and make the sterilization process easier.
The sterilization staff should also be familiar with the assembly trays and know which pieces of equipment might need special treatment, says Mr. Kaczor. Some spine instrumentation is delicate and can break if another instrument is on put top of it during sterilization. All the equipment for a tray should be kept together in facilities dealing with sterilization for multiple spine trays at once. "The department should have a set list of each item and a description of the instrumentation to tell you what goes in each specific tray," says Mr. Kaczor. "Keeping the trays together is more efficient because after sterilization you don't have to go through looking for specific items."
Read more about spine surgery:
- 10 Articles for Spine Practice Management
- Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
- 6 Ways to Avoid Denied Claims for Spine Procedures