title: Surgeon practices regarding infection prevention for pediatric spinal surgery.
abstract: BACKGROUND
  A postoperative spinal infection has significant financial and emotional impact on the patient, family, and health care system. The purpose of this study is to understand approaches used by pediatric spinal surgeons with regard to infection prevention.
  
  
  METHODS
  A survey was electronically distributed to 277 POSNA/SRS members. A total of 123 responses were obtained (44%). Eighty-one percent of participating surgeons were in academic practices. Among responders, 82% have been in practice for >10 years, and only 5% have been in practice <5 years.
  
  
  RESULTS
  Sixty-four percent of surgeons responded that they knew their infection rate over the last year, and average reported rates were 1.3% and 5.3% in idiopathic and neuromuscular patients, respectively. The surgeon estimated rates were 0.5% and 4.4% in similar populations for those who did not exactly know their infection rates. Preoperatively, 50% of surgeons suggest chlrorhexidine use at home. Preoperative labs to stratify risk are obtained in 54% of neuromuscular patients and 9% of all patients. MRSA swabs and urine cultures are used variably preoperatively. IV antibiotic use before incision commonly includes not only cephalosporins (>80%), but also frequently involves vancomycin. Forty-seven percent of neuromuscular patients receive gram-negative coverage, whereas only 11% of idiopathic patients do. Skin preparation methods are highly variable among responding physicians. Vancomycin powder is used with the bone graft in 24% of all patients, with gentamycin and vancomycin used variably in idiopathic and neuromuscular patients. Policies limiting scrub wear out of the hospital and traffic in the operating room, the use of UV lights or negative pressure ventilation, and use of drains were also variable.
  
  
  CONCLUSIONS
  There is significant variability in the current practices of surgeons who perform spinal deformity surgery with regard to infection prevention. Such variability most likely results from a lack of good evidence and may reflect suboptimal care. This data can be used as a starting point to help design and direct multicenter studies with an ultimate goal of reducing infection after spinal deformity surgery.
  
  
  METHODS
  Level V.
authors.affiliation: *Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA †Morgan Stanley Children's Hospital of New York, Manhattan, NY ‡Intermountain Orthopaedics Idaho, Boise, ID §Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Glotzbecker
authors.forename: Michael G
authors.initials: MG
authors.lastname: Vitale
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Shea
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage; D002648:Child; D002710:Chlorhexidine / Q000008:administration & dosage; D003428:Cross Infection / Q000517:prevention & control; D005839:Gentamicins / Q000008:administration & dosage; D019538:Health Care Surveys; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013131:Spine / Q000601:surgery; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D002511:Cephalosporins; D005839:Gentamicins; D014640:Vancomycin; D002710:Chlorhexidine