الفهرس 
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Abstract
SSI is infection occur within 30 days after the operation except when there is an implant left in place and infection appears to be related to the implant. These implant associated infections can be considered up to 1 yr after placement of the implant. The incidence of SSI differs widely from hospital to hospital with average rate in children about 2.5–6.8%.
Risk factors of surgical site infection in children includes; the duration of operation, wound classification, antibiotics usage and underlying illness.
These are some precautions should be taken pre, intra and postoperative to minimize the risk of SSI:
• Advise patients to shower or have a bath (or help patients to shower, bath or bed bath) using soap, either the day before, or on the day of, surgery
• Do not use hair removal routinely to reduce the risk of surgical site infection.
• Staff wearing non-sterile theatre wear should keep their movements in and out of the operating area to a minimum
• Do not use nasal decontamination with topical antimicrobial agents aimed at eliminating Staphylococcus aureus routinely to reduce the risk of surgical site infection.
• No role for mechanical bowel preparation in reducing the risk of surgical site infection.
• Give antibiotic prophylaxis to patients before:
1. clean surgery involving the placement of a prosthesis or implant.
2. clean-contaminated surgery
3. contaminated surgery.
• Do not use antibiotic prophylaxis routinely for clean non-prosthetic uncomplicated surgery.
• Use the local antibiotic formulary and always consider potential adverse effects when choosing specific antibiotics for prophylaxis.
• Consider giving a single dose of antibiotic prophylaxis intravenously on starting anaesthesia. However, give prophylaxis earlier for operations in which a tourniquet is used.
• Before giving antibiotic prophylaxis, consider the timing and pharmacokinetics (for example, the serum half-life) and necessary infusion time of the antibiotic. Give a repeat dose of antibiotic prophylaxis when the operation is longer than the half-life of the antibiotic given.
• Give antibiotic treatment (in addition to prophylaxis) to patients having surgery on a dirty or infected wound.
• Inform patients before the operation, whenver possible, if they will need antibiotic prophylaxis, and afterwards if they have been given antibiotics during their operation.
• The operating team should wash their hands prior to the first operation on the list using an aqueous antiseptic surgical solution, with a single-use brush or pick for the nails, and ensure that hands and nails are visibly clean.
• Before subsequent operations, hands should be washed using either an alcoholic hand rub or an antiseptic surgical solution. If hands are soiled then they should be washed again with an antiseptic surgical solution.
• Do not use non-iodophor-impregnated incise drapes routinely for surgery as they may increase the risk of surgical site infection.
• If an incise drape is required, use an iodophor-impregnated drape unless the patient has an iodine allergy.
• The operating team should wear sterile gowns in the operating theatre during the operation.
• Consider wearing two pairs of sterile gloves when there is a high risk of glove perforation and the consequences of contamination may be serious.
• Prepare the skin at the surgical site immediately before incision using an antiseptic (aqueousor alcohol-based) preparation: povidone-iodine or chlorhexidine are most suitable.
• If diathermy is to be used, ensure that antiseptic skin preparations are dried by evaporation and pooling of alcohol-based preparations is avoided.
• Do not use diathermy for surgical incision to reduce the risk of surgical site infection.
• Maintain patient temperature in line with ‘Inadvertent perioperative hypothermia’
• Maintain optimal oxygenation during surgery. In particular, give patients sufficient oxygen during major surgery and in the recovery period to ensure that a haemoglobin saturation of more than 95% is maintained.
• Maintain adequate perfusion during surgery
• Do not use wound irrigation to reduce the risk of surgical site infection.
• Do not use intracavity lavage to reduce the risk of surgical site infection.
• Do not use intraoperative skin re-disinfection or topical cefotaxime in abdominal surgery to reduce the risk of surgical site infection.
• Cover surgical incisions with an appropriate interactive dressing at the end of the operation.
• Use an aseptic non-touch technique for changing or removing surgical wound dressings.
• Use sterile saline for wound cleansing up to 48 hours after surgery.
• Advise patients that they may shower safely 48 hours after surgery.
• Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus.
• Do not use topical antimicrobial agents for surgical wounds that are healing by primary intention to reduce the risk of surgical site infection.
• When surgical site infection is suspected (i.e. cellulitis), either de novo or because of treatment failure, give the patient an antibiotic that covers the likely causative organisms. Consider local resistance patterns and the results of microbiological tests in choosing an antibiotic.
• Do not use Eusol and gauze, or dextranomer or enzymatic treatments for debridement in the management of surgical site infection.
There are some recent trends in the management of SSI for example the use of medical honey and vacuum-assisted closure method.
SSI is infection occur within 30 days after the operation except when there is an implant left in place and infection appears to be related to the implant. These implant associated infections can be considered up to 1 yr after placement of the implant. The incidence of SSI differs widely from hospital to hospital with average rate in children about 2.5–6.8%.
Risk factors of surgical site infection in children includes; the duration of operation, wound classification, antibiotics usage and underlying illness.
These are some precautions should be taken pre, intra and postoperative to minimize the risk of SSI:
• Advise patients to shower or have a bath (or help patients to shower, bath or bed bath) using soap, either the day before, or on the day of, surgery
• Do not use hair removal routinely to reduce the risk of surgical site infection.
• Staff wearing non-sterile theatre wear should keep their movements in and out of the operating area to a minimum
• Do not use nasal decontamination with topical antimicrobial agents aimed at eliminating Staphylococcus aureus routinely to reduce the risk of surgical site infection.
• No role for mechanical bowel preparation in reducing the risk of surgical site infection.
• Give antibiotic prophylaxis to patients before:
1. clean surgery involving the placement of a prosthesis or implant.
2. clean-contaminated surgery
3. contaminated surgery.
• Do not use antibiotic prophylaxis routinely for clean non-prosthetic uncomplicated surgery.
• Use the local antibiotic formulary and always consider potential adverse effects when choosing specific antibiotics for prophylaxis.
• Consider giving a single dose of antibiotic prophylaxis intravenously on starting anaesthesia. However, give prophylaxis earlier for operations in which a tourniquet is used.
• Before giving antibiotic prophylaxis, consider the timing and pharmacokinetics (for example, the serum half-life) and necessary infusion time of the antibiotic. Give a repeat dose of antibiotic prophylaxis when the operation is longer than the half-life of the antibiotic given.
• Give antibiotic treatment (in addition to prophylaxis) to patients having surgery on a dirty or infected wound.
• Inform patients before the operation, whenver possible, if they will need antibiotic prophylaxis, and afterwards if they have been given antibiotics during their operation.
• The operating team should wash their hands prior to the first operation on the list using an aqueous antiseptic surgical solution, with a single-use brush or pick for the nails, and ensure that hands and nails are visibly clean.
• Before subsequent operations, hands should be washed using either an alcoholic hand rub or an antiseptic surgical solution. If hands are soiled then they should be washed again with an antiseptic surgical solution.
• Do not use non-iodophor-impregnated incise drapes routinely for surgery as they may increase the risk of surgical site infection.
• If an incise drape is required, use an iodophor-impregnated drape unless the patient has an iodine allergy.
• The operating team should wear sterile gowns in the operating theatre during the operation.
• Consider wearing two pairs of sterile gloves when there is a high risk of glove perforation and the consequences of contamination may be serious.
• Prepare the skin at the surgical site immediately before incision using an antiseptic (aqueousor alcohol-based) preparation: povidone-iodine or chlorhexidine are most suitable.
• If diathermy is to be used, ensure that antiseptic skin preparations are dried by evaporation and pooling of alcohol-based preparations is avoided.
• Do not use diathermy for surgical incision to reduce the risk of surgical site infection.
• Maintain patient temperature in line with ‘Inadvertent perioperative hypothermia’
• Maintain optimal oxygenation during surgery. In particular, give patients sufficient oxygen during major surgery and in the recovery period to ensure that a haemoglobin saturation of more than 95% is maintained.
• Maintain adequate perfusion during surgery
• Do not use wound irrigation to reduce the risk of surgical site infection.
• Do not use intracavity lavage to reduce the risk of surgical site infection.
• Do not use intraoperative skin re-disinfection or topical cefotaxime in abdominal surgery to reduce the risk of surgical site infection.
• Cover surgical incisions with an appropriate interactive dressing at the end of the operation.
• Use an aseptic non-touch technique for changing or removing surgical wound dressings.
• Use sterile saline for wound cleansing up to 48 hours after surgery.
• Advise patients that they may shower safely 48 hours after surgery.
• Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus.
• Do not use topical antimicrobial agents for surgical wounds that are healing by primary intention to reduce the risk of surgical site infection.
• When surgical site infection is suspected (i.e. cellulitis), either de novo or because of treatment failure, give the patient an antibiotic that covers the likely causative organisms. Consider local resistance patterns and the results of microbiological tests in choosing an antibiotic.
• Do not use Eusol and gauze, or dextranomer or enzymatic treatments for debridement in the management of surgical site infection.
There are some recent trends in the management of SSI for example the use of medical honey and vacuum-assisted closure method.