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Surgical Site Infection 101

As surgical services improve and move toward ambulatory and Evidence-Based Research
day case surgery, 20–72% of surgical wound infections will present At present, there are no randomised control trials on surgical site
3
clinically only after discharge, so a system of follow-up for case infection in children. Tables 16.2 and 16.3, which present analyses of
finding and reporting is mandatory in the outpatient population as well. paediatric wound infections, are based on reports of large prospective
This may include developing communication lines to local clinics or studies on incidence and risk factors of SSIs.
specific outpatient reviews within 2 weeks of discharge.
It is only by monitoring, reporting, and analyzing SSI incidence Table 16.3: Evidence-based research.
that procedure- or surgeon-specific trends can be determined and
prevention methods put in place. Surgical site infection in children: prospective analysis of the
Title
Table 16.2: Evidence-based research. burden and risk factors in a sub-Saharan African setting
Ameh EA, Mshelbwala PM, Nasir AA, Lukong CS, Jabo BA,
Title Pediatric wound infections: a prospective multicenter study Authors Anumah MA, Nmadu PT
Horwitz JR, Chwals WJ, Doski JJ, Suescun EA, Cheu HW, Division of Pediatric Surgery, Department of Surgery,
Authors Institution
Lally KP Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
University of Texas-Houston Medical School and Herman Reference Surgical Infections (Larchmt) 2009; 10(2):105-9
Children’s Hospital, Houston, Texas, USA; Wilford Hall
Institution USAF Medical Center, San Antonio, Texas, USA; Bownman There is a lack of data regarding the prevalence and risk
factors of surgical site infection in children in Africa. The
Gray School of Medicine, Winston-Salem, North Carolina, Problem problem is to determine the burden and risk factors for SSI
USA
in children in a major teaching hospital in sub-Saharan
Reference Annals of Surgery 1998; 227:553–558 Africa.
To identify risk factors associated with the development of Comparing children who developed wound infection and
Problem Comparison
wound infection in children. those who did not.
Comparing children who developed wound infection and The overall rate of SSI was 23.6%. The SSI rate was 14.3%
Comparison
those who did not. in clean incisions, 19.3% in clean-contaminated incisions,
The overall incidence of wound infection was 4.4%. The Outcome/ 27.3% in contaminated incisions, and 60% in dirty incisions
(p < 0.05). The infection rate was 25.8% in emergency
amount of wound contamination (p = 0.006) and duration effect
Outcome/ of operation (p = 0.03) were found to be significantly procedures and 20.8% in elective procedures (p < 0.05).
The infection rate was 31% in operations lasting 2 hours or
effect associated with a postoperative wound infection. There more and 17.3% in operations lasting less than 2 hours (p
were no significant differences in age, gender, ASA < 0.05).
preoperative assessment score, length of preoperative stay,
and use of perioperative antibiotics. This is the first prospective report of SSI in children in sub-
Saharan Africa. The burden of SSI is high in the setting.
This report of a large series of surgical site infection in The authors attributed this to the lack of definite infection
children with a multicentre approach provides a useful Historical surveillance/control programmes and the tropical climate.
Historical practice guide, although there is the possibility of differences significance/ The degree of incisional contamination and a long duration
significance/ in patient selection and case mix with this approach. The comments of surgery (≥2 hours) are important risk factors. The report
comments authors recommend prospective surveillance of wound draws attention to the lack of hospital infection control
infection in children with feedback to clinicians to reduce the and antibiotic guidelines, and has prompted a proactive
cost of health care associated with wound infection. approach to these issues.
Key Summary Points

1. Surgical site infections are a major cause of morbidity and 5. Antibiotic prophylaxis is not an alternative to maintenance of
increased costs in health care. asepsis.
2. A multitude of risk factors influence the development of 6. SSIs in children are related more to perioperative factors than
SSIs, and awareness of these will help to promote effective to the patients’ overall physiologic status.
preventive strategies. 7. Rigorous adherence to the principles of asepsis by all
3. The degree of wound contamination and duration of surgery scrubbed personnel is the foundation of surgical site infection
are proven risk factors. prevention.
4. Surveillance systems that monitor rates of wound infection
and provide feedback to clinicians have been shown to
contribute to quality improvement and help to prevent and
control infection.

References
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Pediatric Surgery. McGraw-HIll, 2003, Pp 161–178. multicenter study. Ann Surg 1998; 227(4):553–558.
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