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Simon G. Ammanuel, Caleb S. Edwards, Andrew K. Chan, Praveen V. Mummaneni, Joseph Kidane, Enrique Vargas, Sarah D’Souza, Amy D. Nichols, Sujatha Sankaran, Adib A. Abla, Manish K. Aghi, Edward F. Chang, Shawn L. Hervey-Jumper, Sandeep Kunwar, Paul S. Larson, Michael T. Lawton, Philip A. Starr, Philip V. Theodosopoulos, Mitchel S. Berger, and Michael W. McDermott

majority of SSIs. 4 As such, interventions that reduce the number of microbes present on skin preoperatively may be helpful to reduce the SSI rate. One such intervention is the use of chlorhexidine gluconate (CHG) liquid soap when showering on the days prior to surgery. CHG is an antiseptic with broad-spectrum antimicrobial activity. 5 Notably, CHG has been associated with decreased SSI rates after various neurosurgical and nonneurosurgical procedures, ostensibly by reducing native skin microflora. 5–8 One study compared SSI in patients who underwent total joint

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George M. Ghobrial, Michael Y. Wang, Barth A. Green, Howard B. Levene, Glen Manzano, Steven Vanni, Robert M. Starke, George Jimsheleishvili, Kenneth M. Crandall, Marina Dididze, and Allan D. Levi

preparations. 15 On their choice for preoperative skin prophylaxis in spine surgeries, 57%, 53%, and 38% of respondents had used DuraPrep surgical solution (iodine povacrylex and isopropyl alcohol), ChloraPrep (2% chlorhexidine gluconate [CHG] and 70% isopropyl alcohol), and Betadine (7.5% povidone-iodine [PVI] solution), respectively. Some centers use more than one skin prep in succession prior to each surgery, explaining why the total of the listed percentages does not add up to 100%. 15 Two meta-analyses, neither of which is specific to spinal surgery, suggest a benefit

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Ahmed Kashkoush, Nitin Agarwal, Ashley Ayres, Victoria Novak, Yue-Fang Chang, and Robert M. Friedlander

advent of hand hygiene and preoperative scrub and the use of sterile gloves have been linked to lower SSI rates, decreased hospital costs, and improved patient outcomes. 2 , 5 , 10 , 15 , 26 , 47 Across healthcare institutions, multiple hand-scrubbing options are available. Traditionally, surgeons utilize a hand-scrubbing approach, in which an antiseptic solution (either 4% povidone iodine or 4% chlorhexidine gluconate) is vigorously scrubbed from fingertip to elbow for 3–5 minutes and washed with water (“wet scrub”). In contrast, hand-rubbing protocols have recently

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Michael M. H. Yang, Walter Hader, Kelly Bullivant, Mary Brindle, and Jay Riva-Cambrin

.6)  Cystoperitoneal 7 (4.4) 5 (4.6)  Ventriculoatrial 1 (0.6) 1 (0.9)  Lumboperitoneal 0 (0) 1 (0.9) Ventricular catheter  Bioglide 96 (60.8) 9 (8.2) <0.001  Barium impregnated 3 (1.9) 74 (67.3)  Antibiotic impregnated 25 (15.8) 7 (6.4)  Not replaced & unknown 34 (21.5) 20 (18.2) Shunt infection 20 (12.7) 3 (2.7) 0.004 Perfect protocol compliance 0 (0) 77 (70) <0.001 Skin preparation  Chlorhexidine 13 (8.2) 109 (99.1) <0.001 Antibiotics given ≥30 mins prior to incision 24 (15.2) 93 (84.6) <0.001 Postop antibiotics given 136 (86.1) 106 (96.4) 0.005 Values are presented as the number

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Paul T. Akins, John Belko, Amit Banerjee, Kern Guppy, David Herbert, Tamara Slipchenko, Christi DeLemos, and Mark Hawk

investigated the mechanism of spread of MRSA from a neurosurgical patient with MRSA in the sputum, and demonstrated that horizontal surfaces in the room were more likely to harbor the bacteria than vertical surfaces, which is consistent with droplet spread. Chlorhexidine gluconate and benzalkonium chloride were more effective in disinfecting these surfaces than other commonly used disinfectants such as alkyldiaminoethyl glycine (Tego-51). Should the prevalence of MRSA or its presence alter the selection of prophylactic antibiotics for neurosurgical procedures? Hammond and

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Ian K. Pople, Roger Bayston, and Richard D. Hayward

moistened with saline, were applied to the child's skin at the operative sites after dry-shaving the scalp. Sterile surgical gloves were used throughout this procedure and the pads were then imprinted onto blood-agar plates without delay. Skin preparation consisted of an approximately 2-minute application of povidine iodine followed by chlorhexidine in spirit, which was left to dry by evaporation. Wound edges were covered by swabs soaked in either chlorhexidine or povidine iodine. No prophylactic antibiotics were used in any of the patients. Open wounds were sampled for

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Lindsey Spiegelman, Richa Asija, Stephanie L. Da Silva, Mark D. Krieger, and J. Gordon McComb

the reservoir was prepared with chlorhexidine, which was allowed to permeate the scalp for 2 minutes. A 25-gauge butterfly needle was used to tap the reservoir. If the tap was initially unsuccessful, a new 25-gauge butterfly needle was used so that the needle penetrated the scalp only once. The opening pressure was noted by the column of CSF that filled the clear plastic tubing attached to the butterfly needle. Some CSF was then aspirated and submitted for cell count with differential, Gram stain, and culture on agar plates and a broth medium. Both culture media are

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Hansen Deng, Andrew K. Chan, Simon G. Ammanuel, Alvin Y. Chan, Taemin Oh, Henry C. Skrehot, Caleb S. Edwards, Sravani Kondapavulur, Amy D. Nichols, Catherine Liu, John K. Yue, Sanjay S. Dhall, Aaron J. Clark, Dean Chou, Christopher P. Ames, and Praveen V. Mummaneni

capacity to identify risk factors that increase SSI has been limited. To address this gap in knowledge, we systematically evaluated all patients who underwent thoracic or lumbar spine operations from 2012 to 2016 and identified candidate risk factors that were independently associated with SSI. We hypothesize that demographics, comorbidities (including but not limited to DM), and operative variables may be associated with risk of SSI, and that utilization of presurgical chlorhexidine gluconate (CHG) showers by patients may be associated with reduced risks of SSI. Methods

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Nikita G. Alexiades, Edward S. Ahn, Jeffrey P. Blount, Douglas L. Brockmeyer, Samuel R. Browd, Gerald A. Grant, Gregory G. Heuer, Todd C. Hankinson, Bermans J. Iskandar, Andrew Jea, Mark D. Krieger, Jeffrey R. Leonard, David D. Limbrick Jr., Cormac O. Maher, Mark R. Proctor, David I. Sandberg, John C. Wellons III, Belinda Shao, Neil A. Feldstein, and Richard C. E. Anderson

. Do you routinely refer asymptomatic complex tethered cords to urology preoperatively? 2. Do you routinely refer symptomatic complex tethered cords to urology preoperatively? 3. Do you routinely obtain preoperative urine cultures and treat if positive? 4. Do you use preoperative antibacterial (e.g., chlorhexidine) wash or wipes the night prior to surgery? 5. Do you use prophylactic intravenous cefazolin routinely for surgery? 6. Do you routinely administer prophylactic gram-negative antibiotic coverage during surgery? 7. How long do you continue intravenous

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Marike L. D. Broekman, Janneke van Beijnum, Wilco C. Peul, and Luca Regli

example, shampoo with 4% wt/vol chlorhexidine); and perioperative antibiotics protocol. Results The electronic searches of PubMed and Embase detected 165 articles, of which 21 studies—involving 11,071 patients—were suitable for inclusion ( Fig. 1 ). 1 , 3–5 , 7–9 , 11–14 , 16–20 , 23–25 , 27 , 28 Two of these studies were RCTs (Level I evidence). 5 , 8 A short overview of the included articles is presented in Tables 1 – 3 , describing the following aspects: level of evidence; number of patients included; perioperative management regarding shampooing