Spine surgical site infection outcome with preoperative application of a pre-saturated 10% povidone-iodine nasal decolonization product in a 32-bed surgical hospital.

Abstract

Background: To pursue an irreducible minimum overall surgical site infection (SSI) rate, a 32-bed surgical hospital employed an outside consultant and performed sterile processing and surgery internal audits: no obvious improvements were identified. A ten-year review determined 70% of SSI's were spine procedure patients. After a nasal decolonization product literature review an intervention was implemented. The purpose of this study was to assess if the intervention impacted spine SSI rates.

Methods: A 36-month implementation science study was conducted. The 18-month intervention was immediate preoperative application of a manufactured pre-saturated 10% povidone iodine nasal decolonization product in spine surgery patients, with monthly product application documentation surveillance feedback to the preoperative staff. Chi-square test was used to determine the difference in types of spine SSI surgery rates pre and post intervention.

Results: Overall spine SSI decreased 35.7% (p=0.04) with 58.7% reduction in superficial incisional SSI (p=0.02). The 16.1% decline in deep incisional SSI was not significant (p=0.29).

Conclusion: Within this hospital, conducting 7,576 surgical spine procedures over 36-months, with the immediate preoperative application of a pre-saturated ten percent povidone-iodine nasal decolonization product, the only intervention in SSI prevention protocol, produced a statistically significant decrease in spine patient SSI rate percent.