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Methods| The Cleveland Clinic Institutional Review Board approved this pragmatic, quasi-experimental cohort study, and it was conducted between March 2012 and December 2013. Informed consent was not required because this was a quality improvement initiative with minimal risk. A waiver of informed consent was obtained from the institutional review board. In January 2013, an infection prevention bundle was introduced at a single tertiary-care center. Patients undergoing discectomy, decompression, augmentation, or fusion of the spine were included. The analysis of the data was conducted in January 2015.

The bundle included 9 evidence-based components:(1) screening for Staphylococcus aureus nasal colonization and decolonization with mupirocin,(2) self-preparation bath with chlorhexidine gluconate,(3) self-preparation with chlorhexidine gluconate wipes, 6 (4) storage optimization of operating room …