Objective: The aim of this survey was to better understand trends, patterns and practices of DBS surgical site care in the UK.

Background: Deep brain stimulation (DBS) is a well-established treatment for movement disorders. DBS surgical site infection (SSI) rates are varied and underreported. DBS SSI result in high morbidity and explantation rates.
DBS nurse specialists in the UK play a fundamental role in patient selection, pre-op, intra and post-surgery care, and long-term follow-up. DBS nurse specialists are in a key position to identify and manage SSI early, identify risk factors related to DBS infection and gather data in order to improve patient outcomes through the development of national guidance for SSI prevention.

Method: The DBS Nurse Association (DBSNA) committee undertook a cross-sectional survey of 11 DBS centres in the UK using a 21 point questionnaire. The questionnaires were circulated at a national conference, one questionnaire per service. The questionnaires were completed by DBS nurse specialists.
21 questions explored pre-operative infection prevention strategies, surgical techniques, implant numbers, number of surgeons and post-operative care, including prophylactic therapy and activity risks. Information regarding identification and management of surgical site infection was also collected.

Results: 11 UK DBS centres responded to the questionnaire. According to this survey there are more than 400 new DBS devices implanted annually. The reported SSI rate ranges between 1-8%; with most common microorganism identified as Staphylococcus, Pseudomonas and unknown causes. ​There is variability in the use of pre-op antimicrobial washes, wound closure techniques, wound dressing care, antibiotic use and follow up. The majority of centers have reported that there are no written guidelines for surgical site infection. All centres had a comparable explantation risk (mean 48%) post DBS infection.

Conclusion: This survey has shown that there is a wide variation in practice in UK DBS centres. Patients receive different levels of surveillance and may be offered different levels of infection prevention strategies. How certain practices may be associated with higher levels or specific types of infection is not well understood and more research is needed. There is a high rate of explantation and the presence of guidelines to standardise the management of DBS infection may be helpful.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prevention-and-management-of-deep-brain-stimulation-dbs-surgical-site-infections-ssi-multicentre-survey-of-uk-practice/