title: Implementation of a care bundle and evaluation of risk factors for surgical site infection in cranial neurosurgery.
abstract: OBJECTIVE
  Surgical site infection [SSI] increases mortality, morbidity and length of hospital stay. Peri-operative 'care bundles' have reduced SSI in some fields of surgery. The aim of this study was to determine the impact of bundle compliance on SSI in patients undergoing a craniotomy.
  
  
  METHODS
  Cohort study of patients [N=1253] undergoing a craniotomy over 17 months at a single centre. SSI was defined as arising within 30days of operation or 1year where an implant(s) remains. 'Bundle compliance' required administration of antibiotics <60min of induction, maintenance of intraoperative blood sugar (BM) <11mmol and temperature at >36°C. SSI incidence was compared between bundle compliant and non-compliant groups. Case mix adjustment was performed using binary logistic regression.
  
  
  RESULTS
  Over the study period, 1253 procedures were carried out and 66 patients (5.3%) developed a SSI. The majority (38, 57.6%) of these cultured Staphyloccoccus species. Only the use of an implant was found to be an independent risk factor for SSI [AOR 2.5, p<0.005, 95%CI 1.4, 4.3]. The use of the bundle did not reduce the occurrence of SSI.
  
  
  CONCLUSIONS
  An evidence-based bundle did not reduce SSI in this neurosurgical series. The use of an implant was an independent risk factor of its occurrence.
authors.affiliation: Dept. of Neurosurgery, Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust (SRFT), Salford, UK. Electronic address: Benjamin.davies4@nhs.net.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Davies
authors.affiliation: Dept. of Neurosurgery, Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust (SRFT), Salford, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Jones
authors.affiliation: Dept. of Neurosurgery, Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust (SRFT), Salford, UK.
authors.forename: Hiren C
authors.initials: HC
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D064872:Patient Care Bundles / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control
keywords: Care bundle; Cranial neurosurgery; Risk factors; Surgical site infection