521. Pediatric Appendectomy Surgical Site Infection Surveillance
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 521_IDWPOSTER.pdf (189.0 kB)
  • Background: The National Healthcare Safety Network (NHSN) pooled means for appendectomy (appy) surgical site infections (SSIs) are 1.15 & 3.47 for risk levels 0,1 & 2,3 respectively.  Pediatric appy SSI rates in the literature vary from 1.6-20 depending on risk classification. SSI surveillance generally consists of culture review by infection control (IC) and post discharge reporting by surgeons. This method of case finding may underestimate SSI burden as cultures are not always obtained & surgeons may not report patients with SSIs seen as outpatients.   

    Objective: Describe a comprehensive surveillance process, incidence & stratification of pediatric appy SSIs in a tertiary care children's hospital.

    Methods: A collaborative effort between IC and pediatric surgeons was launched to accurately determine incidence & classification of SSIs. Surgeons supplied IC with monthly appy case lists by diagnosis of nonperforated or perforated. IC identified SSIs by review of wound/aspirate cultures & surgeon reports from outpatient clinics. IC also reviewed electronic alerts of all patients readmitted ≤30 days of surgery.  SSIs were reviewed with surgeons for accuracy of classification.  Rates were determined from 10/2010-2/2013 using NHSN definitions. Overall SSI rate, nonperforated superficial & organ space, perforated superficial & organ space SSI rates were calculated. 

    Results: 62 total SSIs: 14.5% (9/62) were nonperforated SSIs, 85% (53/62) were perforated SSIs; of which 88.6% (47/53) were perforated organ space SSIs.  47% (29/62) of infections were diagnosed by clinical symptoms only (purulent drainage, fever, localized pain/tenderness, presence of abscess).  Organisms isolated included Pseudomonas aeruginosa (4), Candida albicans (1), Escherichia coli (6), & several gram positive organisms (3).  31% (19/62) SSIs were poly microbial.

    Conclusion: NHSN appy SSI rates underestimate incidence in the pediatric population.  Patients with a perforated appendix are at high risk of developing an organ space SSI. Collaborative, integrated surveillance between IC and surgeons is vital to accurate SSI case identification and classification.  Effective interventions to decrease the incidence of deep organ space SSI following perforated appy should be prioritized.

    Text Box: NHSN Pooled Mean:
3.47 (Risk Level 2, 3)
1.15 (Risk Level 0,1)
 

    Koya Davis, MPH, MHA, CIC1, Galit Holzmann-Pazgal, MD2, Kevin Lally, MD2, Shauna Levy, MD2 and Kuojen Tsao, MD2, (1)Memorial Hermann Hospital-Texas Medical Center, Houston, TX, (2)University of Texas Medical School, Houston, TX

    Disclosures:

    K. Davis, None

    G. Holzmann-Pazgal, None

    K. Lally, None

    S. Levy, None

    K. Tsao, None

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