Pediatric Surgical Site Infection Surveillance: Going Beyond Targeting Procedures

Background: Few pediatric (ped) surgical site infection (SSI) benchmarks are published. Those found in the literature focus on ped cardiac, neurosurgical, and general procedures.  Therefore, external benchmarks are not available for most ped surgical services.

Objective: To create an internal benchmark for ped cardiac (CARD), neurology (NEUS), orthopedic (ORTS), general (GEN), oral maxillofacial (OMS), plastic (PLA), urology (URO), otolaryngology (OTO), ophthalmology (OPH), vascular (VAS), and transplant (TXP) surgical services and to evaluate the effectiveness of an electronic active surveillance method for SSI following ped surgical procedures.

Methods: From July 08 to June 09, all ped patients who underwent an incisional procedure were included in this study. Aborted or wound class-dirty procedures were excluded. Surveillance for CARD, NEUS, and ORTS surgical patients was based on positive microbiology cultures.  Active surveillance of GEN, OMS, PLA, URO, OTO, OPH, VAS, and TXP services was done through the use of an electronic medical record search engine (EMERSE). All identified SSIs met NHSN criteria and were classified by specific event as superficial (S), deep (D) or organ/space (OS). SSI rates were not risk stratified for this study.

Results: There were 6,603 total procedures performed during the study period with 77 SSIs identified. The surgical service, # of SSIs, # of Procedures, SSI rates and SSI frequency (ƒ) stratified by NHSN specific event classification are listed.

Service	# SSI	# Procedures	Rate (%)	S:D:OS (ƒ)
CARD	15	620	2.42	3:4:8
NEUS	5	457	1.09	1:2:2
ORTS	7	1355	0.52	1:6:0
GEN	32	1093	2.93	16:5:11
OMS	2	129	1.55	1:1:0
PLA	8	507	1.58	5:1:2
URO	3	777	0.39	3:0:0
OTO	3	967	0.31	2:1:0
OPH	2	663	0.30	0:0:2
Total	77	6603	1.15	32:20:25

Positive microbiology results identified 57 SSIs.  Active surveillance with EMERSE identified an additional 20 SSIs, a 35.09% increase in case finding; 15/32 SSIs in GEN, 1/2 SSI in OMS, 2/8 SSIs in PLA, and 2/3 SSIs in URO.  All OTO and OPH SSIs were identified by positive microbiology cultures and active surveillance. VAS and TXP had no infections during the study period.

Conclusions: Calculated SSI rates will serve as an internal benchmark for ped surgical services and may be useful as a benchmark for other ped hospitals. In our hospital, surveillance of OTO and OPTH SSI could be limited to microbiology surveillance as all SSIs identified in this study were culture positive.  GEN, OMS, PLA, and URO services had infections that were only identified by active surveillance and therefore electronic chart review remains the optimal strategy for surveillance for these services.