Spine Journal - 2026-09-12 - Journal Article
Multifaceted infection prevention protocol is associated with reduced surgical site infection after spinal fusion: a before-and-after study.
Sohn HJ, Cho JH, Lee DH, Hwang CJ, Park S
Topics
Key Takeaway
A four-component SSI prevention bundle reduced surgical site infection after spinal fusion from 2.9% to 0.4% (absolute risk reduction 2.5%, p=0.033) in a single-center before-and-after study.
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Summary
This single-center before-and-after study evaluated a four-component SSI prevention protocol—povidone-iodine nasal decolonization, chlorhexidine bathing, enhanced glycemic control, and reinforced aseptic technique—implemented in December 2023 for consecutive spinal instrumentation (NHSN FUSN) cases. SSI incidence by CDC/NHSN criteria dropped from 2.9% (11/377) pre-intervention to 0.4% (1/254) post-intervention. Multivariate Firth-penalized logistic regression identified the protocol as an independent protective factor (aOR 0.18, 95% CI 0.02–0.76, p=0.017).
Key Limitation
With only 12 total SSI events across both cohorts, the confidence intervals on the adjusted odds ratio are extremely wide (0.02–0.76), making precise effect-size estimation unreliable and the finding sensitive to even one or two additional events.
Original Abstract
BACKGROUND CONTEXT
Surgical site infection (SSI) after spinal instrumentation surgery is a serious complication with substantial clinical and economic consequences, and evidence on multifaceted prevention protocols in spine surgery remains limited.
PURPOSE
To evaluate the effectiveness of a multifaceted SSI prevention protocol after spinal fusion surgery.
STUDY DESIGN
Retrospective single-center before-and-after intervention study.
PATIENT SAMPLE
A total of 631 consecutive patients who underwent spinal instrumentation surgery (NHSN procedure code FUSN) between April 2023 and October 2024 (pre-intervention, n=377; post-intervention, n=254).
OUTCOME MEASURES
Incidence of SSI within 3 months after surgery, defined according to the CDC/NHSN surveillance criteria.
METHODS
The protocol, implemented in December 2023, comprised (1) universal preoperative povidone-iodine nasal decolonization, (2) chlorhexidine gluconate bathing, (3) enhanced perioperative glycemic control, and (4) reinforced intraoperative aseptic techniques. Demographics, surgical variables, and SSI rates were compared between groups, and multivariate logistic regression was performed.
RESULTS
The SSI rate decreased from 2.9% (11/377) to 0.4% (1/254) after implementation (absolute risk reduction 2.5%, 95% CI 0.7-4.4%; p=0.033). Groups were comparable in sex, body mass index, smoking status, normothermia, ASA classification, operative time, NNIS risk index, and number of fused levels, although the post-intervention group was younger (median 65.5 vs 68 years; p=0.006). The protocol was an independent protective factor against SSI (Firth-penalized adjusted odds ratio 0.18; 95% CI 0.02-0.76; p=0.017).
CONCLUSIONS
A multifaceted SSI prevention protocol was associated with a significant reduction in SSI after spinal instrumentation surgery, supporting the adoption of standardized, multi-target prevention strategies.