J. M. Podolnick2,3,4, L. R. Putnam2,3,4, S. Sakhuja2,3,4, C. M. Chang2,3,4, M. T. Austin2,3,4, K. P. Lally2,3,4, K. Tsao2,3,4 4Children’s Memorial Hermann Hospital,Houston, TX, USA 2University Of Texas Health Science Center At Houston,Department Of Pediatric Surgery,Houston, TX, USA 3Center For Surgical Trials And Evidence-based Practice,Houston, TX, USA
Introduction:
Skin antisepsis agents are commonly used in an effort to decrease surgical site infections (SSI). However, surgeon preference, anatomical site considerations, and patient age may influence proper agent utilization. Despite institutional adoption of evidence-based guidelines, we hypothesized that adherence to skin preparation guidelines is variable in pediatric operations.
Methods:
A retrospective cohort study of eight common pediatric operations (laparoscopic appendectomy, fundoplication, gastrostomy tube placement, pyloromyotomy, laparoscopic cholecystectomy, abscess incision and drainage, inguinal hernia repair, and stoma takedown) was performed to evaluate the skin prep agents utilized over a one year period. The skin prep used for each operation was recorded as well as patient age, gender, operative time, prep nurse, surgeon, and anatomical site of prep (torso, extremity, pelvis/perineum). Correct prep agent was determined based on adherence to our institutional guidelines based on best-evidence and best-practice in pediatric hospitals. Logistic regression and the chi squared test were performed; p<0.05 was considered significant.
Results:
183 cases were reviewed with an overall adherence of 58% to skin prep guidelines. Adherence was highest for laparoscopic appendectomies and laparoscopic cholecystectomies (92% and 96%, respectively) and lowest for inguinal hernia repairs and stoma takedowns (32% and 8%, respectively). A total of five different skin prep agents or combinations were used with at least two different agents/combinations used per case type; all five were used for appendectomies during the study period (Table). Factors associated with non-adherence included type of operation, surgeon, and patient age.
Conclusion:
Significant variability in adherence to correct skin prep guidelines exists for common pediatric operations. Contributing factors include type of operation, surgeon, and patient age. Consistent practice and adherence to evidence-based guidelines for skin preparation requires targeted interventions in order to optimize skin antisepsis and minimize risk of SSI.
