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Prevention of surgical site infections in pediatric spines: a single-center experience

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Abstract

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

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Acknowledgements

The authors thank Mrs. Martine Diez and Mrs. Sophie Gallot for clinical support. One author (FS) performed this research in the framework of the International PhD in Innovation Sciences and Technologies of the University of Cagliari, Italy.

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Authors and Affiliations

  1. Pediatric Orthopaedic Surgery Unit, Lenval University Children’s Hospital, 57, Av. Californie, 06200, Nice, France

    Federico Solla, Jean-Luc Clément, Yoann Levy, Ioana Oborocianu, Virginie Rampal & Carlo Mario Bertoncelli

  2. Pediatric Anesthesiology Department, Lenval University Children’s Hospital, Nice, France

    Romain Lefèbvre

Authors
  1. Federico Solla
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  2. Romain Lefèbvre
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  3. Jean-Luc Clément
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  4. Yoann Levy
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  5. Ioana Oborocianu
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  6. Virginie Rampal
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  7. Carlo Mario Bertoncelli
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Contributions

FS conceived and performed the study and wrote the article. RL wrote the article and revised the literature. JLC supervised the study and revised the text. YL wrote the article, revised the literature, and collected data. IO revised the literature and revised the text. CMB performed the statistical analysis and revised the text. VR supervised the study and revised the text.

Corresponding authors

Correspondence to Federico Solla or Carlo Mario Bertoncelli.

Ethics declarations

Ethics approval

This study was approved by IRB “South-East France” with number 2012-A01663-40, ref 13.003, and protocol 72082012. The authors confirms that the study was approved by the appropriate institutional research ethics committee and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained by all patients and parents.

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All authors consent for publication.

Conflict of interest

Federico Solla and Jean-Luc Clément received funding for attending congresses from Medicrea Int outside this work. The other authors have no relevant financial or non-financial interests to disclose.

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Solla, F., Lefèbvre, R., Clément, JL. et al. Prevention of surgical site infections in pediatric spines: a single-center experience. Childs Nerv Syst 37, 2299–2304 (2021). https://doi.org/10.1007/s00381-021-05095-x

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  • DOI: https://doi.org/10.1007/s00381-021-05095-x

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