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Impact of the implementation of an interdisciplinary infection control program to prevent surgical wound infection in pediatric heart surgery

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Abstract

Surgical site infection (SSI) remains a major source of morbidity, mortality, and increased health care costs in children undergoing heart surgery. The aim of this study was to assess the effectiveness of an intervention program designed to reduce the high incidence of SSI observed at our center in pediatric patients. An interdisciplinary infection control program including pre-, intra-, and postoperative measures was introduced for children undergoing heart surgery with cardiopulmonary bypass. We conducted a quasi-experimental interventional study comparing a pre-intervention cohort (June 2009 to March 2010) and a post-intervention cohort (July 2011 to July 2012). A significant drop in SSI incidence from 10.9 % (95 % CI 4.7–18.8) to 1.92 % (95 % CI 0.4–5.52) was observed. Variables significantly associated with infection risk were median age (14 days in infected vs 2.3 years in non-infected patients; p < 0.01), hospitalization unit (10.3 % SSI cumulative incidence in the neonatal intensive care unit vs 0 cases in the pediatric intensive care unit; p < 0.01), and median preoperative hospital stay (14 days in infected vs 1 day in non-infected patients; p = 0.03).

Conclusions: The implementation of a new intervention program was associated with an 82 % (95 % CI 34–94) reduction in SSI incidence in children undergoing heart surgery at our center.

What is known:

• Surgical site infection (SSI) is associated with significant morbidity and mortality following pediatric cardiac surgery.

• Younger patients and longer cardiopulmonary bypass times are associated with higher SSI rates.

What is New:

• Comprehensive infection control program including preoperative, intraoperative and postoperative nonpharmacologic measures is a key factor for the prevention of SSI.

• A significant reduction in SSI rates can be achieve despite a narrower-spectrum antibiotic usage.

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Acknowledgments

The authors wish to thank Inma Albero Andrés, RN for her contribution to implementing non-pharmacologic measures and Miss Christine O’Hara for invaluable help in editing the manuscript.

Authors Contribution

Jaume Izquierdo-Blasco: Study conception and design, Acquisition of data, Analysis and interpretation of data and Drafting of manuscript; Pere Soler-Palacín and Joan Sanchez-de-Toledo: Study conception and design, Analysis and interpretation of data, Drafting of manuscript and Critical revision of the manuscript; Magda Campins-Martí: Study conception and design, Analysis and interpretation of data, Statistical analysis and Critical revision of the manuscript; Raúl Abella, Ferran Gran, Joan Balcells, Rosario Nuño and Felix Castillo: Revision of the manuscript

Conflict of interest

The authors declare no conflict of interest and no financial support.

Author information

Author notes

    Authors and Affiliations

    1. Department of Pediatric Intensive Care Medicine, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

      Jaume Izquierdo-Blasco & Joan Balcells

    2. Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

      Magda Campins-Martí

    3. Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

      Pere Soler-Palacín

    4. Department of Pediatric Cardiothoracic Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

      Raul Abella

    5. Department of Pediatric Cardiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

      Ferran Gran

    6. Department of Neonatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

      Félix Castillo

    7. Department of Anesthesiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

      Rosario Nuño

    8. Cardiac Intensive Care Unit, Children’s Hospital of Pittsburgh, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, 15224, USA

      Joan Sanchez-de-Toledo

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    1. Jaume Izquierdo-Blasco
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    2. Magda Campins-Martí
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    9. Joan Sanchez-de-Toledo
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    Corresponding author

    Correspondence to Joan Sanchez-de-Toledo.

    Additional information

    Communicated by Patrick Van Reempts

    Pere Soler-Palacín and Joan Sanchez-de-Toledo contributed equally to the manuscript

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    Izquierdo-Blasco, J., Campins-Martí, M., Soler-Palacín, P. et al. Impact of the implementation of an interdisciplinary infection control program to prevent surgical wound infection in pediatric heart surgery. Eur J Pediatr 174, 957–963 (2015). https://doi.org/10.1007/s00431-015-2493-9

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    • DOI: https://doi.org/10.1007/s00431-015-2493-9

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