S. aureus bacteria exists in the nasal passages 20-80% of patients (1), and the presence of patient carried S. aureus causes a much higher infection rate than non-carriers. (2). In addition to this very significant colonization percentage of patients with S. aureus, there are other patient related factors that can contribute to S. aureus infections. Patient factors in the production of elevated infection rates include obesity, older age, and posterior spine approaches and because of these and other issues, the spinal site “infection rates do not extrapolate to zero.” (3). Under the most rigorous sterile conditions in hospital neurosurgical operating suites, the neurosurgical infection rate of invasive S. aureus (non-superficial or bloodstream carried ) is 1 out of every 161 surgeries. (4) The breech proposed by the plaintiff is inadequate skin prep, however a povidone iodine was and continues to remain as a statistically valid skin prep for surgical procedures. Some studies found no statistical difference between povidone and chlorhexidine as an adequate prep (5-9).
REF:
(1) Front Immunol. 2013; 4: 507. Published online 2014 Jan 8. doi: 10.3389/fimmu.2013.00507 Staphylococcus aureus Colonization: Modulation of Host Immune Response and Impact on Human Vaccine Design
Aisling F. Brown, John M. Leech, Thomas R. Rogers, and Rachel M. McLoughlin
(2) ). J. of Hospital Infection (2008) 68, 25-31 Nasal carriage of S. aureus increases the risk of surgical site infection after major heart surgery P. Mun˜oz a, *, J. Hortal b , M. Giannella a , J.M. Barrio b , M. Rodrı´guez-Cre´ixems a , M.J. Pe´rez b , C. Rinco´n b , E. Bouza a a Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario ‘Gregorio Maran˜o´n’
(3)
Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S125-37.
The influence of perioperative risk factors and therapeutic interventions on infection rates after spine surgery: a systematic review.
Schuster JM,
Rechtine G,
Norvell DC,
Dettori JR.
(4) Infect Control Hosp Epidemiol. 2010 Jul;31(7):701-9.
Variation in the type and frequency of postoperative invasive Staphylococcus aureus infections according to type of surgical procedure.
Anderson DJ,
Arduino JM,
Reed SD,
Sexton DJ,
Kaye KS,
Grussemeyer CA,
Peter SA,
Hardy C,
Choi YI,
Friedman JY,
Fowler VG Jr.
(5) Surg Today. 2014 Nov 9. [Epub ahead of print]
Comparison of the efficacy of chlorhexidine gluconate versus povidone iodine as preoperative skin preparation for the prevention of surgical site infections in clean-contaminated upper abdominal surgeries.
Srinivas A1,
Kaman L,
Raj P,
Gautam V,
Dahiya D,
Singh G,
Singh R,
Medhi B.
(6)
Rev Col Bras Cir. 2013 Nov-Dec;40(6):443-8.
Incidence of surgical site infection with pre-operative skin preparation using 10% polyvidone-iodine and 0.5% chlorhexidine-alcohol.
(7)
Cochrane Database Syst Rev. 2015 Apr 21;4:CD003949. doi: 10.1002/14651858.CD003949.pub4.
Preoperative skin antiseptics for preventing surgical wound infections after clean surgery.
Dumville JC1,
McFarlane E,
Edwards P,
Lipp A,
Holmes A,
Liu Z
(8) Eur J Obstet Gynecol Reprod Biol
2020 Jan;244:45-50.
doi: 10.1016/j.ejogrb.2019.10.035. Epub 2019 Nov 9.
Povidone-iodine vs chlorhexidine alcohol for skin preparation in malignant and premalignant gynaecologic diseases: A randomized controlled study
Sener Gezer 1, Hayriye M Yalvaç 2, Kübra Güngör 2, İzzet Yücesoy 2
(9) Arch Dis Child Fetal Neonatal Ed
2018 Mar;103(2):F101-F106.
doi: 10.1136/archdischild-2016-312193. Epub 2017 Oct 26.
2% chlorhexidine-70% isopropyl alcohol versus 10% povidone-iodine for insertion site cleaning before central line insertion in preterm infants: a randomised trial
Emily A Kieran 1 2 3, Anne O'Sullivan 4, Jan Miletin 4, Anne R Twomey 1, Susan J Knowles 1, Colm Patrick Finbarr O'Donnell 1 2 3
