1427. Scrubbing Technique and Surgical Site Infections: An Analysis of 14,200 Neurosurgical Cases

Authors: Ahmed Ismail Kashkoush; Nitin Agarwal, MD; Robert Friedlander (Pittsburgh, PA)

Introduction: The pre-operative scrub has been shown to lower the incidence of surgical site infections (SSIs). Various scrubbing and gloving techniques exist; however it is unknown how specific scrubbing technique influences SSI rates in neurosurgery. We aim to assess if the range of scrubbing practice in neurosurgery is associated with the incidence of SSIs. Methods: We conducted a retrospective review of a prospectively maintained database to identify all 30-day SSIs for neurosurgical procedures between 2012-2017 at one of our teaching hospitals. SSIs were classified by procedure type (craniotomy, shunt, fusion, or laminectomy). Surveys were administered to attending and resident physicians to understand the variation in scrubbing methods (wet vs. dry, iodine vs. chlorhexidine, single-vs double-glove). Chi-squared followed by multivariate logistic regression analyses were utilized to identify independent predictors of SSI. Results: 42 subjects were included in our study (18 attending physicians, 24 resident physicians), who performed 14,200 total cases. Overall, SSI rates were 2.1% (296 SSIs of 14,200 total cases) and 2.0% (192 of 9,669 cases) for attendings and residents, respectively. Shunts were independently associated with an increased risk of SSI (odds ratio with 95% confidence interval, OR: 2.0 [1.6 – 2.6]), whereas laminectomies were associated with a decreased SSI risk (OR: 0.4 [0.3 – 0.6]). Wet vs. dry scrub (OR: 0.9 [0.7 – 1.1]), iodine vs. chlorhexidine (OR: 1.3 [1.0 – 1.6]), and single- vs. double-gloving (OR: 1.0 [0.8 – 1.3]) preferences were not associated with SSIs. Conclusion: There is no evidence to suggest that perioperative infection is associated with personal scrubbing or gloving preference in neurosurgical procedures.