A Novel Prevention Bundle to Reduce Surgical Site Infections in Pediatric Spinal Fusion Patients

Area of Science:

• Pediatric Surgery
• Infection Control
• Quality Improvement

Background:

• Spinal fusion surgeries carry a high risk of surgical site infections (SF-SSI).
• Despite the implementation of the Surgical Care Improvement Project (SCIP) bundle in 2008, SF-SSI remained prevalent in pediatric spinal fusion patients.
• A need existed for enhanced infection prevention strategies beyond the existing SCIP bundle.

Purpose of the Study:

• To design and implement a comprehensive pre-, peri-, and postoperative bundle (PPPB).
• To achieve sustained reductions in SF-SSI rates for pediatric spinal fusion procedures.
• To evaluate the effectiveness and cost-effectiveness of the developed PPPB.

Main Methods:

• A quality improvement project utilizing a before-and-after trial design was conducted.
• A multidisciplinary team developed the PPPB, integrating SCIP elements with enhanced wound care, nursing protocols, and patient education tools.
• SF-SSI rates were compared before (2008-2010) and after (2011-2015) PPPB implementation, with 100% compliance monitored.

Main Results:

• The study included 224 pediatric spinal fusion surgeries between 2008 and 2015.
• Implementation of the PPPB resulted in a 71% reduction in the mean SF-SSI rate (from 8.2 to 2.4 per 100 surgeries; P=.0695).
• Notably, no SF-SSIs occurred in neuromuscular patients post-PPPB implementation (P=.008).

Conclusions:

• The developed PPPB effectively achieved sustained reductions in SF-SSI rates over a 50-month period.
• The PPPB represents a reproducible model for improving surgical site infection prevention in pediatric spinal fusion.
• The findings support the broader applicability of this enhanced bundle for other surgical procedures.