Reduction of Surgical-site Infections in Neurosurgery—The Advantage of Antiseptics Combined with a Sterile Surface

Abstract

Infection at the operative site is associated with high morbidity, mortality, and prolonged hospitalization. Typically, in neurosurgical cases the infection rate varies between 1 and 4%. The rise in antimicrobial resistance makes pre-operative methods to reduce surgical-site infection even more important. This is essential since hospitalized patients tend to have a higher frequency of resistant organisms, and the rise in methicillin-resistant Staphylococcus aureus (MRSA) infections has made antibiotic prophylaxis of this highly virulent organism more difficult. In this article we consider the role of pre-operative antisepsis, which aims to reduce bacterial density in the operative site, and the development of a sterile surface concept as part of an approach to reduce surgical-site infection in a neurosurgical setting. The risk for surgical-site infection is proportional to residual bacteria at the wound site, so a reduction in skin bacterial density will be associated with a concomitant reduction in surgical-site infection. 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.