Active Epidemiological Surveillance: the Key for Effective Infection Prevention in Pediatric Surgery

Abstract

Approaches to the prevention of surgical site infections (SSI) in pediatric surgery is an extrapolation of data obtained mainly from studies in the adult surgical patients. In Russia, data on the actual incidence of SSI in pediatric surgery are almost nonexistent. It is known that one of the reasons for the low effectiveness of SSI prevention is a weak system of epidemiological surveillance, which leads to an underestimation of risk factors and the urgency of the problem. A number of preventive measures aimed at preventing of SSI have shown efficacy in adult surgical patients. One of the leading position belongs to antimicrobial prophylaxis. The study was conducted in St. Petersburg State Children's city hospital № 19 named after K. A. Rauhfus. The data were obtained during a retrospective and prospective epidemiological surveillance among patients of surgical units.It has been shown that SSIs in children have high morbidity. The effectiveness of detecting the real incidence of SSI depends on the methods of epidemiological surveillance: 3.8 per 100 surgeries using standard approaches of surveillance and 11.6 using specially developed forms of active epidemiological surveillance. The incidence of SSI varied depending on the type of surgical unit: 3.8 per 100 surgeries in the traumatology unit, 7.1 in the neurosurgical unit and 15.3 in the general surgery unit. In the etiologic structure, S. aureus predominates (46.5%), E. coli (22.2%) and S. epidermidis (16.7%) were respectively in the second and third positions. It has been shown that antimicrobial prophylaxis is an effective measure for prevention of SSI in pediatric surgery (the odds ratio OR in the case-control study was 0.52 (95% CI = 0.3–0.8)).

Keywords

• health care associated infection
• surgical site infection
• pediatric surgery