Post-craniotomy wound care protocol improves appearance, reduces infection

Post-craniotomy wound care protocol improves appearance, reduces infection

Procedure created by multidisciplinary team at UCI Medical Center reduced surgical site infection by 50%

Orange, Calif. - A new post-brain surgery wound care protocol significantly reduced the risk of surgical infection and improved the appearance of the incision, a study led by UCI Health researchers has found. A multidisciplinary team consisting of neurosurgeons, neurosurgical nurse specialists, wound care specialists, and infection prevention experts developed an innovative and effective method for postoperative wound care where no standard currently exists.

"Postoperative wound care protocol prevents surgical site infection after craniotomy," was published on Oct. 14 in Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. UCI Health epidemiologist Dr. Mariya Kovryga-Kornick was the study's lead investigator. Infectious diseases expert Dr. Susan Huang was the senior investigator.

Improved appearance, reduced infection risk

To examine the effectiveness of a multistep process designed to minimize the risk of surgical wound infection, the team studied 3,560 craniotomies at UCI Medical Center, the flagship of UCI Health: 1,251 were studied in the 24 months before the protocol, 2,309 in the 48 months after the protocol.

The procedure substantially improved the appearance of the wound, with 46% fewer incisional clots, 65% less redness, 68% less greasy hair and 90% less wound drainage.

It also reduced surgical site infection by 50%, from 2.4% before implementation of the protocol to 1.4% after the protocol.

Dr. Jefferson Chen, professor and acting chair of the Department of Neurological Surgery at UC Irvine School of Medicine and co-author of the paper, said "This success highlights the importance of a concerted and organized performance improvement effort involving neurosurgeons, infection prevention, and specialty nursing staff."

Wound care protocol

The wound care procedure involved:

• Using soft ties to keep hair away from the wound
• Cleansing the wound and the surrounding 2 inches of skin with 2% leave-on chlorhexidine (CHG) beginning on the day after surgery or when the dressing is removed
• Using 2% warmed CHG cloths to remove incisional clots, which can support bacterial growth
• Shampooing hair with 4% rinse-off CHG beginning three days after surgery and every three days thereafter

Photos surveys were also conducted twice weekly. The team used standardized national criteria to measure the impact on surgical site infections.

Potential impact

There are nearly 50,000 craniotomies performed in the U.S. every year, with the risk of infection varying between 3% and 10%.

Craniotomy wounds are especially predisposed to infection. The scalp also has a high degree of blood flow, which can lead to clots forming in the incision, providing room for bacteria growth.

"This protocol has the exciting potential to reduce the risk of serious infections in the thousands of patients who require brain surgery each year," says Kovryga Kornick.

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About UCI Health

UCI Health, one of California's largest academic health systems, is the clinical enterprise of the University of California, Irvine. The system comprises its main campus UCI Medical Center, a 459-bed, acute care hospital in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Recognized as a Top Hospital by The Leapfrog Group, UCI Medical Center provides tertiary and quaternary care and is home to Orange County's only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow us on Facebook, Instagram, LinkedIn and Twitter.

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