Purpose: To describe the potential issues in the methodology of surgical site infection (SSI) prevention and how it was investigated and corrected in a single institution.
Methods: A pediatric orthopedic unit experienced an increase of SSI, concerning up to 10% of scoliosis surgery cases from 2011 to 2013. An institutional procedure of multimodal and interdisciplinary risk evaluation was initiated, including a review of the literature, a morbi-mortality meeting, internal and external audits concerning the hygiene conditions in the operating room, the antibiotic prophylaxis, patients, and sterile material pathways. Several preventive actions were implemented, including the improvement of air treatment in the operating room, wound irrigation with 2L of saline before closure, application of topic vancomycine in the wound, verification of doses and timing of antibiotics injection, and use of waterproof bandages. We compared the rates of spine SSI before (retrospective group, 2011-2013) and after the implementation of various preventive measures (prospective group, 2014-2018).
Results: SSI occurred in 12 patients (6 idiopathic and 6 neuromuscular) out of 120 operated on (93 idiopathic, 18 neuromuscular, 9 others) in the retrospective group and 2 (both neuromuscular) out of 196 (150 idiopathic, 33 neuromuscular,13 others) in the prospective group (10% vs 1%, odds ratio=9.7, p=0.001). The groups were comparable for age, etiology, duration of surgery, body mass index, American Society of Anesthesiologists score, number of levels fused, and blood loss (p>0.2).
Conclusion: The systematic analysis of SSI allowed for the understanding of the failures and correcting them. The current process is effectively preventing SSI.
Level of evidence: 3: prospective series with case-control analysis.
Keywords: Adolescent; Audit; Morbi-mortality; Pediatric; Prevention; Scoliosis; Surgical site infection.