Surgical site infections (SSI) are infections that occur in tissues or organs that a surgeon has incised or come into contact with during the course of a surgical procedure or operation. Despite advances in the understanding of risk factors, pathogenesis, and prophylaxis, SSI are still a significant source of morbidity for children who undergo operative procedures. Estimated to occur in 2–6% of children who undergo an operation, SSI in some studies account for up to early one quarter of all nosocomial infections in this age group.1–7 For the individual, an SSI can mean prolongation of the hospital stay, additional surgical interventions, the risk of further complications and, most importantly, unnecessary pain and anxiety. For society, the treatment of these largely preventable complications substantially increases the overall cost of health care, as the cost of treatment for each patient with an SSI increases by an average of approximately 36%.8
It should be noted that nearly all of the studies regarding the microbiology, pathogenesis, prevention, and treatment of SSI have been conducted in adults. Because of the present dearth of studies involving children, we have no choice but to apply the same principles used in adults, with modifications where clinical experience and good judgment dictate.
In the past, subjective terms such as “postoperative wound infection” or “wound abscess” were commonly used to describe SSI and, unless defined very clearly by the author who used them, it was often difficult to understand exactly which disease processes were being discussed. In 1970, the Centers for Disease Control and Prevention (CDC) established the National Nosocomial Infections Surveillance (NNIS) System (now the National Healthcare Safety Network [NHSN]), which eventually helped to more precisely define the various types of SSI.9 (Table 69–1 and Figure 69–1). The use of these definitions has allowed more accurate comparisons between studies and, perhaps more importantly, has provided a basis for standardization of the criteria used in surveillance programs throughout the United States. These programs and subsequent studies that resulted have provided an abundance of useful data over the past 15–20 years and have helped to enhance our understanding of the risk factors and pathogenesis of SSI.
Table 69–1. Criteria for Defining Surgical Site Infections (SSI)9 |Favorite Table|Download (.pdf)
Table 69–1. Criteria for Defining Surgical Site Infections (SSI)9
Type of SSI
Skin and/or subcutaneous tissues
At least one of the following:
- Purulent drainage from superficial incision
- Positive wound culture
- Signs of infection†and wound is opened by surgeon‡
- Diagnosis of superficial incisional SSI made by surgeon
Do not report: stitch abscess, or circumcision, episiotomy, or burn infections
Fascia and/or muscle
At least one of the following:
- Purulent drainage from deep incision
- Signs of infection and wound is opened by surgeon or wound dehisces‡
- Abscess or infection noted on examination, at ...