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Pediatrics. 2014 Oct;134(4):e1174-80. doi: 10.1542/peds.2014-0097. Epub 2014 Sep 8.

A statewide collaborative to reduce pediatric surgical site infections.

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Rainbow Babies and Children's Hospital, Cleveland, Ohio;
Rainbow Babies and Children's Hospital, Cleveland, Ohio;
Nationwide Children's Hospital, Columbus, Ohio; and.
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.



Surgical site infections (SSIs) are preventable events associated with significant morbidity and cost. Few interventions have been tested to reduce SSIs in children.


A quality improvement collaboration was established in Ohio composed of all referral children's hospitals. Collaborative leaders developed an SSI reduction bundle for selected cardiac, orthopedic, and neurologic operations. The bundle was composed of 3 elements: prohibition of razors for skin preparation, chlorhexidine-alcohol use for incisional site preparation, and correct timing of prophylactic antibiotic administration. The incidence of SSIs across the collaborative was compared before and after institution of the bundle. The association between 1 of the bundle elements, namely correct timing of antibiotic prophylaxis, and the proportion of centers achieving 0 SSIs per month was measured.


Eight pediatric hospitals participated. The proportion of months in which 0 SSIs per center was recorded was 56.9% before introduction of the bundle, versus 81.8% during the intervention (P < .001). Correct timing of preoperative prophylactic antibiotics also significantly improved; 39.4% of centers recorded correct timing in every eligible surgical procedure per month ("perfect timing") before the intervention versus 78.7% after (P < .001). The achievement of 0 SSIs per center in a given month was associated with the achievement of perfect antibiotic timing for that month (P < .003).


A statewide collaborative of children's hospitals was successful in reducing the occurrence of SSIs across Ohio.


nosocomial infections; prophylactic antibiotics; quality improvement; surgical site infection

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