Prospective Surveillance of Surgical Site Infections in a Greek Children's Hospital

Zoi Papanikolaou, Anastasia Dimopoulou, Katerina Mougkou, Georgia Kourlaba, Efthymios Choidis, Sofia Kouni, Stefania Maroudi-Manta, Susan Coffin, Theoklis Zaoutis, and Athanasia Lourida
Infectious Disease (ID) Week
San Francisco, California, October 2-6, 2013

BACKGROUND: Surgical site infections (SSIs) are the second most common health care-associated infection (HAI) in adults and children. There is a paucity of data in children especially in Europe. HAIs are of particular concern in Greece because the strains placed on the healthcare system by the financial crisis. The objective of the study was to determine the incidence of SSIs in children undergoing general surgical procedures. 

METHODS: We conducted prospective surveillance for SSIs on a general surgical ward in the largest children’s hospital in Greece. Surveillance was conducted on all patients who underwent a surgical procedure between January-March 2013. Case finding included daily review of medical and operative records for all surgical patients who remained hospitalized and telephone follow-up at 30 days after surgery. SSIs were defined using the Centers for Disease Control and Prevention National Healthcare Safety Network definitions.

RESULTS: 163 children underwent surgery during the surveillance period. The most frequent procedures were appendectomy, 20.3% (31/153), inguinal hernia repair, 13.1% (20/153), orchiopexy, 12,4% (19/153), circumcision, 12.4% (19/153) and hydrocele repair, 7.2% (11/153). Seven SSIs were detected resulting in overall rate of 4.6 per 100 procedures. All SSI were detected during the index hospitalization and were classified as superficial wound infections. The rate of SSI after clean-contaminated procedures was 2.7 (3 of 109) and after dirty-infected procedures was 26.6 (4 of 15) per 100 procedures. The SSI rate in the most common procedure performed, appendectomy, was 9.3 (4/43) per 100 procedures. 

CONCLUSION: This is the first study to estimate the rate of SSI in children in Greece and one of the few prospective surveillance studies in Europe. Additional surveillance data are needed to provide more robust estimate of the SSI rate in this population.  Future studies are needed to evaluate infection control processes related to the operating room as well as the appropriate use of antimicrobial prophylaxis.