Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug;10(5):633-639.
doi: 10.1177/2192568219868200. Epub 2019 Aug 8.

Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit

Geoffrey A Tipper  1 , Lillian Chiwera  2 , Jonathan Lucas  2
Affiliations

Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit

Geoffrey A Tipper et al. Global Spine J. 2020 Aug.

Abstract

Study design: Single-center prospective cohort.

Objectives: To evaluate a multidisciplinary led, structured protocol for reducing surgical site infections (SSIs) in pediatric scoliosis surgery.

Methods: Following a spike to 8.6% in local annual infection rate, a multidisciplinary team was convened to identify interventions. The team consisted of spinal surgeons, infectious diseases consultants, physiotherapists, specialist nurses, and theatre managers. A protocol was initiated, including preoperative skin decontamination; standardized operative site prepreparation; betadine-soaked swabs sutured to wound edges; blood loss minimization; 3 L0.9% saline pulsed-lavage; defined protocol of glove changes; antibiotic regime of preoperative gentamicin, intraoperative subfascial vancomycin powder, 48-hour cefuroxime; and intraoperative normothermia. A 4-year audit was initiated of all patients aged ≤18 years undergoing corrective spinal deformity surgery. Institutional board review was not required.

Results: Between January 1, 2014 and January 1, 2018, 414 operations were performed on 355 patients: male:female = 1:2.2, mean age 13.7 years (range 2.5-17.9), 233 idiopathic (mean operated vertebral levels 12), 122 neuromuscular (mean operated vertebral levels 14), 66 growing rod procedures, 41 multistage procedures. The mean number of operated vertebral levels both overall and in infected cases was 13 (range 2-17). Nine SSIs occurred in 8 patients at 3 months (4 neuromuscular), resulting in an overall SSI per operation of 2.2%.

Conclusion: A multidisciplinary approach with standardized measures significantly reduced SSIs in the unit's pediatric scoliosis surgery.

Keywords: multidisciplinary; prophylaxis; scoliosis; surgical site infection.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Public Health England (PHE) criteria for identification of surgical site infections (SSIs).
Figure 2.
Figure 2.
Aqueous betadine (7.5%)–soaked swabs applied to wound edges.
See this image and copyright information in PMC

References

    1. de Jonge SW, Gans SL, Atema JJ, Solomkin JS, Dellinger PE, Boermeester MA. Timing of preoperative antibiotic prophylaxis in 54 552 patients and the risk of surgical site infection: a systematic review and meta-analysis. Medicine (Baltimore). 2017;96:e6903. - PMC - PubMed
    1. Kang DG, Holekamp TF, Wagner SC, Lehman RA., Jr Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: a systematic literature review. Spine J. 2015;15:762–770. - PubMed
    1. Hemani ML, Lepor H. Skin preparation for the prevention of surgical site infection: which agent is best? Rev Urol. 2009;11:190–195. - PMC - PubMed
    1. Ballard MR, Miller NH, Nyquist AC, Elise B, Baulesh DM, Erickson MA. A multidisciplinary approach improves infection rates in pediatric spine surgery. J Pediatr Orthop. 2012;32:266–270. - PubMed
    1. Borden TC, Bellaire LL, Fletcher ND. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach. J Multidiscip Healthc. 2016;9:435–445. - PMC - PubMed

LinkOut - more resources