Implementation of surgical site infection prophylaxis in children - a cross sectional prospective study.

Abstract

Background Surgical Site Infections (SSI) are a common cause for morbidity and mortality in both adults and children. In paediatric surgery, evidence on specific prevention measures is lacking and practice mainly depends on local guidelines and treating team's preferences. Aim We aimed to investigate current practice for children undergoing surgery with respect to SSI prevention using a standardized surveillance tool. Methods Nine Swiss paediatric surgery centres participated in a standard period prevalence study. SSI prevention measures were recorded in these hospitals during seven consecutive days in October 2022 for any paediatric surgical procedure resulting in a surgical wound. The SSI prevention measures of interest were drawn from the most recent WHO guidelines. Findings 351 procedures were included. All Swiss language regions were represented. Traumatologic/orthopaedic surgeries were most common. Surgical antibiotic prophylaxis was administered in 161/351 (46%) of all cases, though in 33/161 (21%) of cases, there was no indication for the administration of antibiotics. Alcohol-based or iodine-based solutions were most often used for surgical skin preparation. Antimicrobial-coated sutures were only used in 84/351 (24%) of cases. Regional differences in prevention measures were noted between participating centres for skin preparation solution, suture material, wound dressing, and implementation of warming devices. Conclusion This study provides an overview of current SSI prevention practices in Swiss paediatric surgery centers, identifies targets for improvement, and highlights areas of clinical uncertainty requiring further investigation. The findings underscore the need for standardized guidelines to ensure consistent and evidence-based SSI prevention strategies in paediatric surgery.