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Surgical site infection prevention protocol for pediatric spinal deformity surgery: does it make a difference?
Connie Poe-Kochert1,2, Jilan L Shimberg2, George H Thompson1,2
1Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, USA.
Insights
A standardized care bundle significantly reduced surgical site infections (SSIs) in pediatric spinal deformity surgery. This infection reduction protocol improved patient outcomes, decreasing overall SSIs from 7.2% to 2.5%.
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.
Study Design:
Retrospective.
Objective:
Can a standardized, hospital-wide care bundle decrease surgical site infection (SSI) rate in pediatric spinal deformity surgery? SSI is a major concern in pediatric spinal deformity surgery.
Methods:
We performed a retrospective review of our primary scoliosis surgeries between 1999 and 2017. In 2008, we implemented a standardized infection reduction bundle. Interventions included preoperative nares screening for methicillin-resistant staphylococcus aureus or methicillin-sensitive Staphylococcus aureus 2 weeks preoperatively, and treatment with intranasal mupirocin when positive, a bath or shower the night before surgery, a preoperative chlorohexidine scrub, timing of standardized antibiotic administration, standardized intraoperative re-dosing of antibiotics, limiting operating room traffic, and standardized postoperative wound care. In 2011, we added intrawound vancomycin powder at wound closure. Our inclusion criteria were patients 21 years of age or less with idiopathic, neuromuscular, syndromic, or congenital scoliosis who had a primary spinal fusion or a same day anterior and posterior spine fusion with segmental spinal instrumentation of six levels or more. We compared the incidence of early (within 90 days of surgery) and late (> 91 days) SSI during the first postoperative year.
Results:
There were 804 patients who met inclusion criteria: 404 in the non-bundle group (NBG) for cases prior to protocol change and 400 in the bundle group (BG) for cases after the protocol change. Postoperatively, there were 29 infections (7.2% of total cases) in the NBG: 9 early (2.2%) and 20 late (5.0%) while in the BG there were only 10 infection (2.5%): 6 early (1.5%) and 4 late (1.0%). The reduction in overall SSIs was statistically significant (p = 0.01). There was a trend toward decreased early infections in the BG, without reaching statistical significance (p = 0.14).
Conclusion:
Standardized care bundles appear effective in reducing the incidence of postoperative pediatric spine SSIs.
Level Of Evidence:
Level III.
