Orange, Calif., Oct. 14, 2024 – 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 multi-step 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, who is Professor and Acting Chair of Neurological Surgery 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. In the initial days following surgery, hair cannot be washed, and unclean hair may fall into the wound. The scalp also has a high degree of blood flow, which can lead to clots forming in the incision, providing room for bacteria growth.
Dr. Kovryga Kornick believes that “This protocol has the exciting potential to reduce the risk of serious infections in the thousands of patients who require brain surgery each year.”
