1375. Changes in Operating Room Attire Do Not Reduce Rates of Surgical Site Infections in Patients Undergoing Craniotomy for Tumor Resection

Award: Second Place Socioeconomic Eposter Award

Authors: Kwanza Tamu Warren; Tyler Schmidt, MD; Samuel Tomlinson; Brian Ayers; Kristopher Kimmell, MD; G Vates (Rochester, NY)

Introduction:

Surgical site infections (SSIs) within 30 days of an operation can cause substantial morbidity and economic consequences. Operating room attire has been cited as a key factor in reducing rates of SSIs. In 2015, the Association of peri-Operative Registered Nurses (AORN) advised the use of hoods or bouffant-style head coverings in the operating room instead of surgical caps, and this recommendation was widely adopted. We sought to evaluate the rates of SSIs in patients undergoing craniotomy for tumor resection before and after the enforcement of the AORN guidelines.

Methods:

Patients undergoing craniotomy for tumor resection were identified using the American College of Surgeons/National Surgical Quality Improvement Program (ACS/NSQIP) database from 2005 to 2016. All patients with clean surgical procedures (wound class I) were included. Patients were divided into two groups based on the timing of the procedure before or after the implementation of AORN guidelines. Information regarding other known risk factors for SSIs were collected including body mass index, diabetes mellitus, operative time, preoperative sepsis, steroid use, and need for intraoperative blood transfusions.

Results:

Out of 23,294 patients, 13,538 had craniotomy before dissemination of AORN guidelines and 9,756 patients had craniotomy after. The rate of SSIs increased by 0.09% from 1.82% to 1.91%, though this difference was not statistically significant (p=0.65). There were no statistically significant differences between the two groups in the proportion of patients with diabetes mellitus, morbid obesity, preoperative sepsis or need for blood transfusions. Operative time was an average of 10.73 minutes longer (p < 0.0001) in the pre-guideline group and 17.29% of patients in the pre-guideline group used steroids compared to 14.33% of patients in the post-guideline group (p<0.0001).

Conclusion:

Use of AORN-recommended bouffant-style head coverings by operating room personnel did not decrease SSI rates in patients undergoing class I craniotomy for tumor resection.