Acta Neurochirurgica

, Volume 161, Issue 6, pp 1067–1068 | Cite as

Ensuring safe surgery is more than just tackling antimicrobial resistance: making the case for a skin preparation trial

In response to “The implementation of an infection bundle reduces surgical site infections following cranial surgery” (23 Oct 2018)
  • Joseph HamiltonEmail author
  • Hiren C. Patel
  • Benjamin M. Davies
Letter to the editor - Infection
Part of the following topical collections:
  1. Infection

Dear Editor,

The recent Public Health England report [12] has refocused UK attention on the impeding perils of antibiotic resistance, generating headlines such as 3million operations could be deadly if antibiotic resistance worsens [9]. Whilst the mainstream narrative has focused on strategies to reduce resistance, including specific government funding of £30million [6], it is also important attention is given to strategies that reduce our reliance on antibiotics; in the case of safe surgery, this includes skin preparation. With this in mind, we welcomed the work of Jörger et al. in further contributing to the effort to significantly reduce surgical site infection [SSI] in neurosurgery using a peri-operative bundle. This contained five steps; pre-operative octenadine wash by the patient, double octenadine pre-operative skin preparation, staff training, no prophylactic peri-operative cortisol administration and skin closure with glue. They achieved an impressive 50% reduction in SSI [


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Anderson M, Horn M, Lin Y, Parks P, Peterson M (2010) Efficacy of concurrent application of chlorhexidine gluconate and povidone iodine against six nosocomial pathogens. Am J Infect Control 38(10):826–831CrossRefGoogle Scholar
  2. 2.
    Bobby S, Michael DJ, Hiren P, Benjamin D (2018) Current preoperative antisepsis in neurosurgery: an example of the challenges in implementing evidence-based medicine to surgical practice. Ann R Coll Surg Engl:1–6Google Scholar
  3. 3.
    Davies B, Jones A, Patel H (2016) Implementation of a care bundle and evaluation of risk factors for surgical site infection in cranial neurosurgery. Clin Neurol Neurosurg 144:121–125CrossRefGoogle Scholar
  4. 4.
    Edwards P, Lipp A, Holmes A, Dumville J, McFarlane E (2013) Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev.
  5. 5.
    Geube E, Bakker H, Houtman P, van Noort-Klassen M, Pelk M, Sassen T, Wille J (2004) Promoting quality through surveillance of surgical site infections: five prevention success stories. Am J Infect Control 32(7):424–430CrossRefGoogle Scholar
  6. 6.
    GOV.UK (2019) £30 million of funding to tackle antimicrobial resistance. In: GOV.UK. Accessed 13 Feb 2019
  7. 7.
    Jörger A-K, Wimmer N, Lange N, Wagner A, Janssen I, Krieg S, Meyer B, Shiban E (2018) The implementation of an infection prevention bundle reduces surgical site infections following cranial surgery. Acta Neurochir.
  8. 8.
    Koburger T, Hubner N, Braun M, Siebert J, Kramer A (2010) Standardized comparison of antiseptic efficacy of triclosan, PVP-iodine, octenidine dihydrochloride, polyhexanide and chlorhexidine digluconate. J Antimicrob Chemother 65(8):1712–1719CrossRefGoogle Scholar
  9. 9.
    Hagan P (2018) DEADLY as politics MOST POPULAR 3million operations could be DEADLY if antibiotic resistance worsens. The SunGoogle Scholar
  10. 10.
    NICE (2019) Surgical site infection | guidance and guidelines | NICE. In: Accessed 13 Feb 2019
  11. 11.
    Patel H, Davies B (2016) Systematic review and meta-analysis of preoperative antisepsis with combination chlorhexidine and povidone-iodine. Surg J 02(03):e70–e77CrossRefGoogle Scholar
  12. 12.
    Public Health England (2018) English surveillance programme for antimicrobial utilisation and resistance ( ESPAUR ) report 2018. Accessed 13 Feb 2019

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The University of Cambridge School of Clinical MedicineUniversity of CambridgeCambridgeUK
  2. 2.Department of NeurosurgerySalford Royal Foundation TrustSalfordUK
  3. 3.Department of NeurosurgeryAddenbrooke’s HospitalCambridgeUK

Personalised recommendations