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Grid Surgical Infection Surveillance

Summary: GRID implants are used in pediatric and adult populations to determine the foci of seizures and to determine if the foci can be safely ressected to control seizures. Medical charts for GRID implant recipients are reviewed regularly for clinical signs of infection. Infections are classifed as either incisional wound infections or deep surgical site infections. Determination of infection, and the existence of purulent drainage, can be confirmed based on information from surgical housestaff or attending surgeons. These data can be based on notes in the patient record, or from a verbal description. Information concerning purulent drainage received from surgical RNs must be reviewed with the patient's most senior available surgeon

Eligible Patients
All patients that have undergone GRID implants

Surveillance Definition of Infection
Incisional wound infection: One of the following within 30 days after surgery:

  • Purulent drainage from the postoperative wound
  • Surgeon's diagnosis of incisional wound infection
Deep surgical site infection: One of the following:
  • Infection of implanted GRID hardware diagnosed by surgeon
  • Surgeon's diagnosis of intracranial infection (brain abscess; epidural or subdural infection) without involvement of the GRID hardware occurring within 60 days of GRID implant procedures
  • Osteomyelitis of cranial flap, diagnosed by surgeon or by histopathology within one year of GRID implant surgery.
  • Meningitis occurring after GRID implantation and until 30 days after GRID removal and meeting the following criteria:
    • fever (> 38° C) with headache, nuchal rigidity, or meningeal signs and at least one of the following:
    • increased WBCs, elevated protein and/or decreased glucose in CSF
    • Organisms seen on Gram stain of CSF
    • Organism isolated from culture of CSF

III. Procedural Notes

Infections are to be recorded once per patient per surgical site (i.e. incisional, GRID, intracranial, osteomyelitis, meningitis).

Diagnosis of infection will be accepted from surgical housestaff or attending surgeons from notes in the patient record or verbal description.

Documentation of purulent drainage will be accepted from surgical housestaff or attending surgeons from notes in the patient record or verbal description.

Documentation of purulent drainage by surgical RNs will be reviewed with the patient's most senior available surgeon to verify the presence of purulent drainage.

For prospective surveillance only, uncertainties about either the diagnosis of surgical site infection or the presence of purulent drainage should be resolved by discussion with the patient's most senior available surgeon before the infection is recorded.