Related Experiment Video
Updated: Nov 16, 2025
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Prevention of surgical site infections in pediatric spines: a single-center experience
Federico Solla1, Romain Lefèbvre2, Jean-Luc Clément3
1Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, 57, Av. Californie, 06200, Nice, France. fedesolla@hotmail.com.
Insights
Implementing a multimodal approach significantly reduced surgical site infections (SSI) in pediatric orthopedic surgery. This systematic analysis and intervention strategy proved effective in preventing SSIs.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Pediatric orthopedic units can experience significant surgical site infection (SSI) rates, impacting patient outcomes.
- A notable increase in SSIs, reaching 10% in scoliosis surgeries, prompted an institutional review.
- Multimodal risk evaluation is crucial for identifying and addressing infection sources.
Purpose of the Study:
- To identify and rectify methodological issues in surgical site infection (SSI) prevention.
- To evaluate the effectiveness of implemented interventions in reducing SSIs in a pediatric orthopedic unit.
Main Methods:
- Conducted a multimodal, interdisciplinary risk evaluation including literature review, audits, and morbi-mortality meetings.
- Implemented targeted preventive actions: improved OR air treatment, standardized wound irrigation, topical vancomycin, optimized antibiotic prophylaxis, and waterproof bandages.
- Compared SSI rates retrospectively (2011-2013) and prospectively (2014-2018) following intervention implementation.
Main Results:
- Surgical site infection rates decreased from 10% in the retrospective group to 1% in the prospective group (odds ratio = 9.7, p=0.001).
- The prospective group showed a significant reduction in SSIs, with only 2 cases compared to 12 in the retrospective group.
- Patient demographics and surgical characteristics were comparable between the groups, supporting the intervention's efficacy.
Conclusions:
- Systematic analysis of surgical site infections is vital for understanding and correcting failures in prevention strategies.
- The implemented systematic, interdisciplinary approach effectively prevents surgical site infections in pediatric orthopedic surgery.
- Continuous quality improvement initiatives are essential for maintaining low SSI rates.
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.
