Although surgical site infection after craniotomy (SSI-CRAN) is a serious complication, risk factors for its development have not been well defined. We aim to identify the risk factors for developing ...SSI-CRAN in a large prospective cohort of adult patients undergoing craniotomy.
A series of consecutive patients who underwent craniotomy at a university hospital from January 2013 to December 2015 were prospectively assessed. Demographic, epidemiological, surgical, clinical and microbiological data were collected. Patients were followed up in an active post-discharge surveillance programm e for up to one year after surgery. Multivariate analysis was carried out to identify independent risk factors for SSI-CRAN.
Among the 595 patients who underwent craniotomy, 91 (15.3%) episodes of SSI-CRAN were recorded, 67 (73.6%) of which were organ/space. Baseline demographic characteristics were similar among patients who developed SSI-CRAN and those who did not. The most frequent causative Gram-positive organisms were
(23.1%) and
(23.1%), whereas
(12.1%) was the most commonly isolated Gram-negative agent. In the univariate analysis the factors associated with SSI-CRAN were ASA score > 2 (48.4% vs. 35.5% in SSI-CRAN and no SSI-CRAN respectively,
= 0.025), extrinsic tumour (28.6% vs. 19.2%,
= 0.05), and re-intervention (4.4% vs. 1.4%,
= < 0.001). In the multivariate analysis, ASA score > 2 (AOR: 2.26, 95% CI: 1.32-3.87;
= .003) and re-intervention (OR: 8.93, 95% CI: 5.33-14.96;
< 0.001) were the only factors independently associated with SSI-CRAN.
The risk factors and causative agents of SSI-CRAN identified in this study should be considered in the design of preventive strategies aimed to reduce the incidence of this serious complication.
To identify opinions of Primary Healthcare nurses on the use and usefulness of standardised nursing care plans and traditional nursing language systems in the practice settings.
Multicentre, ...observational, cross-sectional study.
Primary Healthcare centres in Catalonia.
Sample size was estimated at 1,668 registered nurses. Consecutive sampling was applied.
On-line survey containing questions on ease, usefulness, and use of nursing care plans and standardised nursing language systems.
Descriptive statistics, including percentages, central tendency, and dispersion measures. Statistical significance was set at P≤.05.
The final analysis included 1,813 questionnaires. Participants stated that care plans have a medium added value, however their use is frequently incorrect. They stated to have a fair level of knowledge on traditional standardised nursing languages, and most were of the opinion that these languages are difficult to use in practice (81%) and not useful to represent nursing care provision and its outcomes (78%). Regardless of their education level and years of experience, the participants assessed as insufficient the clarity (P=.058), ease of use (P=.240), and usefulness (P=.039) of these language systems in practice.
Nurses say that urgent changes are required in the use of care plans. This includes changing the language systems, and improving data and information that positively impacts on the provision of nursing care, as well as to enhance the health outcomes of the individuals receiving Primary Healthcare services.
Abstract
Background
Although surgical site infections after a craniotomy (SSI-CRANs) are a serious problem that involves significant morbidity and costs, information on their prevention is scarce. We ...aimed to determine whether the implementation of a care bundle was effective in preventing SSI-CRANs.
Methods
A historical control study was used to evaluate the care bundle, which included a preoperative shower with 4% chlorhexidine soap, appropriate hair removal, adequate preoperative systemic antibiotic prophylaxis, the administration of 1 g of vancomycin powder into the subgaleal space before closing, and a postoperative dressing of the incisional surgical wound with a sterile absorbent cover. Patients were divided into 2 groups: preintervention (January 2013 to December 2015) and intervention (January 2016 to December 2017). The primary study end point was the incidence of SSI-CRANs within 1 year postsurgery. Propensity score matching was performed, and differences between the 2 study periods were assessed using Cox regression models.
Results
A total of 595 and 422 patients were included in the preintervention and intervention periods, respectively. The incidence of SSI-CRANs was lower in the intervention period (15.3% vs 3.5%; P < .001). Using a propensity score model, 421 pairs of patients were matched. The care bundle intervention was independently associated with a reduced incidence of SSI-CRANs (adjusted odds ratio, 0.23; 95% confidence interval, .13–.40; P < .001).
Conclusions
The care bundle intervention was effective in reducing SSI-CRAN rates. The implementation of this multimodal preventive strategy should be considered in centers with high SSI-CRAN incidences.
This historical control pre–post intervention study involving 1017 consecutive patients undergoing a craniotomy, who were carefully followed-up, found that the implementation of a preventive care bundle was highly effective in reducing the incidence of surgical site infections.
Surgical site infections after craniotomy (SSI-CRAN) significantly impact patient outcomes and healthcare costs by increasing length of stay and readmission and reoperation rates. However, to our ...knowledge, no study has yet analysed the economic impact of a surgical care bundle for preventing SSI-CRAN. The aim is to analyse the hospital cost saving after implementation of a care bundle for the prevention of SSI-CRAN.
A retrospective cost-analysis was performed, considering two periods: pre-care bundle (2013-2015) and care bundle (2016-2017). A bottom-up approach was used to calculate the costs associated with infection in patients who developed a SSI-CRAN in comparison to those who did not, in both periods and on a patient-by-patient basis. The derived cost of SSI-CRAN was calculated considering: (1) cost of the antibiotic treatment, (2) cost of length of stay in the neurosurgery ward within the 1-year follow up period, (3) cost of the re-intervention, and (4) cost of the implant for cranial reconstruction, when necessary.
A total of 595 patients were included in the pre-care bundle period and 422 in the care bundle period. Mean cost of a craniotomy procedure was approximately €8000, rising to €24,000 in the case of SSI-CRAN. Mean yearly hospital costs fell by €502,857 in the care bundle period (€714,886 vs. €212,029). Extra costs between periods were mainly due to increased length of hospital stay (€573,555.3 vs. €183,958.9; difference: €389,596.4), followed by the cost of implant for cranial reconstruction (€69,803.4 vs. €9,936; difference: €59,867.4). Overall, implementation of the care bundle saved the hospital €500,844.3/year.
The implementation of a care bundle for SSI-CRAN had a significant economic impact. Hospitals should consider the deployment of this multimodal preventive strategy to reduce their SSI-CRAN rates, and also their costs.
Identificar la opinión de las enfermeras de atención primaria sobre el uso y la utilidad de los planes de cuidados y los lenguajes estandarizados tradicionales en la práctica asistencial.
Estudio ...descriptivo, transversal, multicéntrico.
Equipos y dispositivos de atención primaria en Cataluña.
Se estimó una muestra necesaria de 1.668 enfermeras y se aplicó una técnica de muestreo consecutivo.
Cuestionario de acceso on-line con preguntas sobre la percepción de facilidad, utilidad y uso de los planes de cuidados y los lenguajes estandarizados tradicionales.
Estadísticos descriptivos con proporciones, medidas de tendencia central y de dispersión. La significación estadística se estableció si p≤0,05.
Se analizaron 1.813 cuestionarios. Las participantes opinaron que los planes de cuidados tienen un valor añadido medio, aunque su uso es con frecuencia incorrecto. Refirieron un nivel de conocimientos adecuado sobre los lenguajes estandarizados, y en su mayoría (81%) opinaron que son difíciles de emplear en la práctica y que son poco útiles para representar la prestación de cuidados y sus resultados (78%). Independientemente de su nivel académico y de los años de experiencia, valoraron como insuficiente la claridad (p=0,058), facilidad de uso (p=0,240) y utilidad de los lenguajes estandarizados (p=0,039).
Las enfermeras urgen a introducir cambios en el uso de los planes de cuidados, incluyendo el cambio de lenguaje, para mejorar los datos y la información que revierta positivamente la prestación de cuidados para la mejora de los resultados de salud de las personas beneficiarias de los servicios de atención primaria.
To identify opinions of Primary Healthcare nurses on the use and usefulness of standardised nursing care plans and traditional nursing language systems in the practice settings.
Multicentre, observational, cross-sectional study.
Primary Healthcare centres in Catalonia.
Sample size was estimated at 1,668 registered nurses. Consecutive sampling was applied.
On-line survey containing questions on ease, usefulness, and use of nursing care plans and standardised nursing language systems.
Descriptive statistics, including percentages, central tendency, and dispersion measures. Statistical significance was set at P≤.05.
The final analysis included 1,813 questionnaires. Participants stated that care plans have a medium added value, however their use is frequently incorrect. They stated to have a fair level of knowledge on traditional standardised nursing languages, and most were of the opinion that these languages are difficult to use in practice (81%) and not useful to represent nursing care provision and its outcomes (78%). Regardless of their education level and years of experience, the participants assessed as insufficient the clarity (P=.058), ease of use (P=.240), and usefulness (P=.039) of these language systems in practice.
Nurses say that urgent changes are required in the use of care plans. This includes changing the language systems, and improving data and information that positively impacts on the provision of nursing care, as well as to enhance the health outcomes of the individuals receiving Primary Healthcare services.
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