A standardized perioperative surgical site infection care process among children with stoma closure: a before-after study.
BACKGROUND
We report on the effectiveness of a standardized perioperative care process for lowering surgical site infection (SSI) rates among children with stoma closure at a tertiary-care public pediatric teaching hospital in Mexico City.


METHODS
All consecutive children with stoma closure operated on between November 2003 and October 2005 were prospectively followed for 30 days postoperatively. We conducted a before-after study to evaluate standardized perioperative bowel- and abdominal-wall care process results on SSI rates.


RESULTS
Seventy-one patients were operated on, and all completed follow-up. SSI rates declined from 42.8% (12/28) before to 13.9% (6/43) after the standardization procedure (relative risk (RR) = 3.1; 95% confidence interval (CI) = 1.3-7.2; p = 0.006). SSI independently associated risk factors comprised peristomal skin inflammation >3 mm (odds ratio (OR) = 9.6; 95% CI = 1.8-49.6; p = 0.007) and intraoperative complications (OR = 13.3; 95% CI = 1.4-127.2; p = 0.02). Being operated on during the after-study period was shown to be a protective factor against SSI (OR = 0.2; 95% CI = 0.4-0.97; p = 0.04).


CONCLUSIONS
Standardization was able to reduce SSI rates threefold in children with stoma closure in a short period of time.
Departamento de Cirugia General, Hospital Infantil de Mexico Federico Gomez, Dr. Marquez 162, Colonia Doctores, Mexico City, Mexico. juandporras@yahoo.com.mx
Juan
J
Porras-Hernandez
Eduardo
E
Bracho-Blanchet
Jose
J
Tovilla-Mercado
Diana
D
Vilar-Compte
Jaime
J
Nieto-Zermeño
Roberto
R
Davila-Perez
Gustavo
G
Teyssier-Morales
Martha
M
Lule-Dominguez
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000379:methods / Q000592:standards*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D015999:Multivariate Analysis; D019990:Perioperative Care / Q000592:standards*; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D054047:Surgical Stomas / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*