Surgical Site Infection After Skin Excisions in Children: Is Field Sterility Sufficient?

Abstract

Skin excisions are common procedures in children. They may be performed in the clinic using field sterility or the operating room with strict sterile technique. We compared the effect of these locations and the use of antibiotics on the incidence of surgical site infection (SSI) after skin excisions. Patients ages 0-18 years presenting to our department for the excision of lesions from 2006 to 2010 with complete medical records were included in our study. Records were reviewed for demographic characteristics, presentation, perioperative conditions, and postoperative SSI and other wound complications. Analyses were performed to estimate the costs associated with sterility technique and perioperative antibiotic use. We identified 700 patients with a mean age of 9.1 years. Of 872 lesions excised, 0.3% resulted in SSI and 1.8% had other wound complications. The incidence of SSI did not vary according to sterility technique, antibiotic usage, surgeon, age, or lesion size, type, or location. The equipment costs to excise a lesion in the operating room were 200% greater than in the clinic. The incidence of SSI after excision of benign lesions in children did not differ between those performed using clinic field sterility and those using the standard aseptic sterile technique in the operating room. A considerable cost savings could be realized by adopting field sterility for simple excisions performed in the operating room and avoiding routine perioperative antibiotics in pediatric skin excisions.

Are Specific Body Sites Prone for Wound Infection After Skin Surgery? A Systematic Review and Meta-Analysis

“…According to the quality assessment, 8 studies were of good, 8,[11][12][13][14][15]19,23 4 of fair, 10,17,18,21 and 6 of poor quality. 6,7,9,16,20,22 In most trials (n 5 10), the study cohort was truly or somewhat representative. In all the studies, participants were drawn from the same exposed cohort and data were extracted from secured records.…”

“…Meta-analysis of 7 studies showed no risk difference for SSI between the scalp and other body sites (RR 1.14, CI 0.40-3.27, I 2 5 47%, see Supplemental Digital Content, Figure S7, http://links.lww.com/DSS/B4). 7,[11][12][13]15,[17][18][19][20] Heterogeneity was moderate. Three studies were of good or fair quality, and 1 study showed high risk of bias.…”

“…Meta-analysis of 9 trials yielded significantly lower wound infection rates on the trunk (RR 0.75, CI 0.58–0.96, I 2 = 0%, Figure 2). 6,7,12,13,15,17–20 Heterogeneity was not important. The results were based on 4 studies of good, 2 of fair, and 3 of poor quality.…”

Dispelling myths in dermatologic surgery

“…Sterile gloves used in the context of aseptic operating room conditions would better distinguish the role of sterile conditions in decreasing risk of SSI (28). To that end, a study conducted by Nuzzi et al (29) evaluated SSI rates for pediatric patients undergoing skin excisions in both outpatient and operating room settings. The incidence of SSI did not vary for different types of excisions, sterile technique, antibiotic usage, or patient age.…”

Doing Our Part to Reduce Medical Costs

“…The article “Surgical Site Infection After Skin Excisions in Children: Is Field Sterility Sufficient?” by Nuzzi et al attempts to address the question of whether, for dermatology procedures, we can do more to rein in costs for procedures in the operating room. The authors demonstrate that, for the population studied, there is no sign of increase in wound infections, indicating that added draping adds unnecessary expense without benefit in these cases.…”