Surgery
Clinical neurosurgical experience supports the utility of 3M™Ioban™2™. For eight years it has been a standard approach to uniformly use 3M™Ioban™2™ for both spinal surgery and the implantation of electrodes into the subthalamic nucleus for Parkinson’s disease (see Figure 3). In a series of 125 patients given a bilateral implantation for Parkinson’s disease in the subthalamic nucleus, 250 electrodes were implanted and no infections of the intracranial electrodes were noted after a median survey time of more than one year. Given that the duration of the operation was approximately four hours, it is clear that additional protection beyond the use of wide-spectrum antiseptics becomes necessary to maintain a lower risk of surgical- site infection by reducing the cutaneous flora. Similarly, between January and June 2009, 182 patients underwent disc repair, and there has been one case of discitis, yielding an infection rate of 0.54% (GKN, unpublished data).
1. 2. 3. 4. 5. 6. 7. 8. 9.
Pessaux P, Atallah D, Lermite E, et al., Risk factors for prediction of surgical site infections in “clean surgery”, Am J Infect Control, 2005;33(5):292–8.
Quinn A, Hill AD, Humphreys H, Evolving issues in the prevention of surgical site infections, Surgeon, 2009;7(3): 170–72.
Parks PJ. Patient preoperative skin preparations to reduce surgical site infections, Future Directions in Surgery, 2006;84–7.
Dohmen P, Antibiotic resistance in common pathogens reinforces the need to minimise surgical site infections, J Hosp Infect, 2008;70(S2):15–20.
Perl TM, Prevention of Staphylococcus aureus infections among surgical patients: Beyond traditional perioperative prophylaxis, Surgery, 2003;134:S10–S17.
Larson E, McGinley K, Foglia A, et al., Composition and antimicrobic resistance of skin flora in hospitalized and healthy adults, J Clin Microbiol, 1986;23(3):604–8.
Larson EL, Cronquist AB, Whittier S, et al., Differences in skin flora between inpatients and chronically ill outpatients, Heart Lung, 2000;29:298–305.
Milstone AM, Passaretti CL, Perl TM, Chlorhexidine: expanding the armamentarium for infection control and prevention, Clin Infect Dis, 2008;46:274–81.
Dormont D, How to limit the spread of Creutzfeldt-Jakob disease, Infect Control Hosp Epidemiol, 1996;17(8):521–8.
10. Dohmen P, Influence of skin flora and preventive measures on surgical site infection during cardiac surgery, Surg Infections, 2006;7(Suppl. 1):S13–S17.
11. Mangram AJ, Horan TC, Pearson ML, et al., Guideline for prevention of surgical site infection, 1999, Am J Infect Control, 1999;27(2):97–132.
12. Tanner J, Woodings D, Moncaster K. Preoperative hair removal to reduce surgical site infection (Review), Cochrane Database Syst Rev, 2009;CD004122(3).
13. Narotam P, van Dellen J, du Trevous M, et al., Operative sepsis in neurosurgery: a method of classifying surgical cases, Neurosurgery, 1994;34(3):409–15.
14. Parks P, Roessmann U, Central nervous system reactions to Conclusion
As with other device-related infections, meticulous surgical methods must be coupled with a process of infection reduction, which can be improved by the production of a sterile surface. The risk for surgical-site infection is proportional to the number of residual bacteria at the wound site, so a reduction in skin bacterial density will be associated with a concomitant reduction in surgical-site infection. In any situation, a randomized prospective clinical study generally carries the highest evidence of proof of efficacy of a given treatment regimen. However, in the presence of low infection rates, sample sizes become too large for such a study and the decision to use a given agent must rest on other information. The cumulative in vitro and in vivo evidence related to wound contamination and extensive clinical experience with implanted neurosurgical devices illustrate the utility of using 3M™Ioban™2 as part of an infection prevention regimen within neurosurgery. n
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