Post-operative Wound Care Protocol Prevents Surgical Site Infection After Craniotomy

ABSTRACT

Background Surgical Site Infections (SSIs) following craniotomy may be affected by extensive head vasculature. Attentive post-operative wound care to keep hair away, cleanse skin, and remove incisional clots that provide nutrients for organisms may help prevent SSIs. Methods In 2018, 72% of craniotomy SSIs at an academic medical center were related to post-operative wound disruption, drainage, and compromised wound healing. These SSIs involved Gram-positive organisms, consistent with skin flora. In January 2019, a post-operative wound care protocol developed by neurosurgical nurse and wound care specialists, and the infection prevention program was initiated, involving 1) soft bands to keep the incision clear of hair, and 2) 2% chlorhexidine gluconate (CHG) cloths to clean the incision and the proximal 6-inches of any drains, remove incisional clots, and clean adjacent skin and hair within 2 inches of the incision. Twice-weekly photos were taken of post-operative craniotomy wounds with protocol lapses and real-time feedback was provided to the bedside nurse, wound care nurse, and surgeon from February 2019-February 2020. Due to the Coronavirus Disease 2019 pandemic (COVID-19), the program progressively lapsed until January 2021, when it was reinstated. SSI rates were compared during the periods with and without the intervention using a chi-square test. Results Baseline Craniotomy SSI rate prior to January 2019 was 3.8% (5/133, SIR=2.6) and 1.7% (16/952, SIR=1.1) during the first intervention period. During COVID-19 surge, SSIs increased to 3.6% (5/140, SIR=2.3) without the intervention, and were restored to a lower rate, 1.6% (2/128, SIR=0.9) after the intervention was reinstituted. SSI rates were lower in intervention (1.7% (18/1080)) versus non-intervention periods (3.7% (10/273)), p=0.04. Conclusions A post-operative inpatient craniotomy wound care protocol involving hair care, incisional CHG cleansing and clot removal, plus photo documentation and feedback for protocol adherence was associated with SSI reduction.