Surgical site infection prevention protocol for pediatric spinal deformity surgery: does it make a difference?

Area of Science:

• Pediatric Orthopedics
• Infectious Disease Prevention
• Surgical Safety

Background:

• Surgical site infections (SSIs) are a significant complication in pediatric spinal deformity surgery.
• Implementing standardized protocols is crucial for mitigating infection risks in this vulnerable patient population.

Purpose of the Study:

• To evaluate the effectiveness of a hospital-wide standardized care bundle in reducing the rate of SSIs in pediatric spinal deformity surgery.
• To assess the impact of specific interventions on early and late postoperative infection rates.

Main Methods:

• A retrospective review of pediatric scoliosis surgeries performed between 1999 and 2017.
• Comparison of SSI rates before (non-bundle group, NBG) and after (bundle group, BG) the implementation of a standardized infection reduction bundle in 2008.
• The bundle included preoperative screening and treatment for Staphylococcus aureus, enhanced surgical hygiene, optimized antibiotic administration, and wound care protocols, with intrawound vancomycin added in 2011.

Main Results:

• The overall SSI rate decreased significantly from 7.2% in the NBG (404 patients) to 2.5% in the BG (400 patients) (p=0.01).
• Early SSIs decreased from 2.2% to 1.5%, and late SSIs decreased from 5.0% to 1.0% in the BG compared to the NBG.
• While not statistically significant, there was a trend towards reduced early infections in the bundle group.

Conclusions:

• Standardized care bundles are effective in reducing the incidence of postoperative SSIs in pediatric spinal deformity surgery.
• The comprehensive infection reduction strategy demonstrates a significant positive impact on patient safety and surgical outcomes.