Infection Prevention Bundle in Brain Tumor Surgery
Infection Prevention Bundle in Brain Tumor Surgery
This study aimed to evaluate the effectiveness of an infection prevention bundle on surgical
 site infections in patients undergone brain tumor surgery. The patients were divided into 2
 groups: infection prevention bundle group and control group
In cranial neurosurgery, surgical site infections (SSIs) occur in 0.5%-7.2% of patients,
 frequently require reoperations and long-lasting antibiotic treatment, and are often life
 threatening.

 Patients with malignant brain tumors often harbor several potential risk factors for SSI such
 as advanced age, poor nutritional state owing to appetite loss, poor sanitary condition of
 the head skin due to low performance status, immunosuppression caused by steroid or
 chemotherapeutic agents, and surgical site skin problems caused by post-operative
 irradiation. Therefore, patients with malignant brain tumors theoretically are a high-risk
 group for SSI.

 A care bundle technique, which is an aggregate of evidence-based practices expected to
 improve patient outcomes, has been introduced to reduce the incidence of SSI.

 The infection prevention bundle (IPB) implemented items:

 1. Preoperative counseling and questionnaire: patient counseling and preparation
 instructions, screening questions for signs of infection, and presence of open or
 nonhealing wounds.

 2. Nasal methicillin-resistant and methicillin-sensitive Staphylococcus aureus
 decolonization: preoperative 24 hours ago twice-daily application of 2% mupirocin
 ointment to bilateral nares with final application on the morning of surgery.

 3. Body decolonization: Cleansing with 4% chlorhexidine gluconate shower the evening before
 surgery and the morning of surgery.

 4. Preoperative weight-based antibiotics within 60 minutes of incision

 5. Strict draping and surgical techniques the standardization

 6. Irrigation of the surgical site with warm Isotonic NaCl solution before skin closure

 7. Postoperative wound care education to patient and family

 Care bundle in preventing surgical site infections is an approach that requires team-based
 service delivery and physician-nurse cooperation. Although it is known abroad and use of
 existing care bundle is not a new concept in Turkey, much is unknown, it is determined that
 widespread and effective use. Experimental studies on the care bundles are needed especially
 in our country to prevent surgical site infections.
Inclusion Criteria:

 -  Patients with American Society of Anesthesiologists score I-II-III

 -  Surgical intervention planned with the diagnosis of brain tumor

 -  No systemic infection such as sepsis, pneumonia, blood infections, or intracranial
 infection such as meningitis, abscess or local infection.

 -  Not having a mental illness

 Exclusion Criteria:

 -  Being morbidly obese (BMI> 40kg / m2)

 -  Immune deficiency

 -  Using immunosuppressive drugs

 -  Being addicted to alcohol and substances

 -  Having received radiotherapy and / or chemotherapy before surgery

 -  Having the disease that requires infective endocarditis prophylaxis (Rheumatic valve
 diseases, prosthetic heart valves, previous endocarditis, etc.)

 -  Corruption of cranium integrity and emergency surgery planned

 -  Having systemic or intracranial infections

 -  Transfenoidal surgery intervention planned

 -  Using implants during surgical intervention

 -  Using external ventricular drainage / lumbar drainage during and after surgical
 intervention