SSIs for Kids Down by 58% With Better Prep, Antibiotic Timing

Surgical site infections (SSIs) among children dropped by 58% at pediatric hospitals across Ohio that employed a trio of interventions that included prohibiting razors for skin preparation, using chlorhexidine-alcohol to disinfect the incision site, and perfectly timing administration of antibiotics before incision, according to a new study by Philip Toltzis, MD, from the Rainbow Babies and Children's Hospital, Cleveland, Ohio, and coauthors, who reported the outcomes from the statewide quality-improvement collaboration in an article published online September 8 in Pediatrics.

According to the authors, hospital-acquired SSIs are very costly in terms of lives lost and treatment dollars spent, but they are also very preventable. The collaboration sought to do just that, dropping SSI rates to a goal of zero by applying best practices for adult patients to the pediatric setting.

Ohio's 8 principal pediatric hospitals participated in the quality-improvement intervention, composed of 3 stages, including the February 1, 2010, to January 31, 2012, intervention period. Each hospital formed a leadership team tasked with SSI reduction, and team members received training in the Institute for Healthcare Improvement's Model for Improvement.

The team members applied the SSI reduction bundle to clean surgical procedures, including cardiac surgery requiring cardiopulmonary bypass, orthopedic surgery involving the spine, and primary placement of an internalized cerebrospinal fluid shunt, Dr. Toltzis and colleagues write.

During the baseline period, SSIs occurred at a rate of 4.48 infections per 100 surgical procedures. During the intervention period, SSIs occurred in 1.89 infections per 100 procedures, which is a 58% reduction. SSI incidence was reduced by 44% in orthopedic surgery cases, 67% in neurosurgery cases, and 72% in cardiothoracic surgery cases.

During the intervention period, all hospitals that performed eligible surgeries achieved a perfect zero SSIs for the month on 6 different months. To ensure SSI numbers do not creep back up, staff members at each pediatric center have continued to share data in monthly teleconferences,. Each hospital has expanded the intervention bundle, adding such items as controlling temperature and blood glucose during the surgical procedure.

"A statewide collaborative using Model for Improvement techniques was successful in substantially reducing the incidence of SSIs in children across Ohio," Dr. Toltzis and coauthors write.

Financial support for the study was provided by the Ohio Business Roundtable, the Cardinal Health Foundation, and the Ohio Children's Hospital Association. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online September 8, 2014. Abstract

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