Study of surgical site infection in children undergoing major surgery: a cross- sectional study

Background Surgical site infections (SSI) is one of the leading cause of hospital-acquired infection in children, leading to prolonged hospital stays, higher economic burden, and increased morbidity. Despite its clinical significance, studies focusing on pediatrics remain limited, particularly in low- and middle-income countries. The objective is to determine the incidence, nature, risk factors, and outcomes of SSIs in children undergoing major surgery in Dhaka, Bangladesh. Methods This descriptive cross-sectional study was conducted from June 2015 to September 2016 in three tertiary hospitals in Dhaka. A total of 384 pediatric patients (< 18 years) undergoing major surgery were evaluated. Wounds were classified according to CDC and ZINN 2012 guidelines. Data on demographics, wound type, risk factors, nutritional status, perioperative care, intraoperative factors, and outcomes were collected and analyzed using SPSS. Results The overall incidence of SSI was 18.7%, with superficial (33.3%), deep (44.4%), and organ-space (22.3%) infections observed. Clean-contaminated wounds (24.5%) carried the highest risk. Malnourished children were four times more likely to develop SSI than well-nourished peers (OR = 4.05, 95% CI: 2.23–7.41). Significant risk factors included prolonged preoperative stay, emergency procedures, intraoperative complications (extensive dissection, prolonged exposure, bleeding, hematoma), blood transfusions, and lack of prior correction of risk factors (p ≤ 0.05). SSI markedly increased postoperative hospital stay, with infected patients requiring up to 15 additional days compared with non-infected patients. Conclusion SSI remains a substantial burden among pediatric surgical patients in Bangladesh. Strengthening infection control practices, optimizing nutritional status, minimizing perioperative risks, and implementing standardized prevention protocols are essential to improve outcomes and reduce economic impact.