Eliminating Sternal Wound Infections: Why Every Cardiac Surgery Program Needs an I Hate Infections Team

Overview

Journal JTCVS Tech

Date 2023 Jun 16

PMID 37324338

Authors

Maren Downing

Michael Modrow

Kelly A Thompson-Brazill

J Erin Ledford

Charles D Harr

Judson B Williams

Affiliations

Soon will be listed here.

Abstract

Objectives: The majority of studies examining deep sternal wound infection (DSWI) prevention focus on ameliorating 1 variable at a time. There is a paucity of data regarding the synergistic effects of combining clinical and environmental interventions. This article describes an interdisciplinary, multimodal approach to eliminate DSWIs at a large community hospital.

Methods: We developed a robust, multidisciplinary infection prevention team to evaluate and act in all phases of perioperative care to achieve a cardiac surgery DSWI rate of 0, named: the I hate infections team. The team identified opportunities for improved care and best practices and implemented changes on an ongoing basis.

Results: Patient-related interventions consisted of preoperative methicillin-resistant identification, individualized perioperative antibiotics, antimicrobial dosing strategies, and maintenance of normothermia. Operative-related interventions involved glycemic control, sternal adhesives, medications and hemostasis, rigid sternal fixation for high-risk patients, chlorhexidine gluconate dressings over invasive lines, and use of disposable health care equipment. Environment-related interventions included optimizing operating room ventilation and terminal cleaning, reducing airborne particle counts, and decreasing foot traffic. Together, these interventions reduced the DSWI incidence from 1.6% preintervention to 0% for 12 consecutive months after full bundle implementation.

Conclusions: A multidisciplinary team focused on eliminating DSWI identified known risk factors and implemented evidence-based interventions in each phase of care to ameliorate risk. Although the influence of each individual intervention on DSWI remains unknown, use of the bundled infection prevention approach reduced the incidence to 0 for the first 12 months after implementation.

Citing Articles

Results of a postoperative telemedicine trial after cardiac surgery and incorporation into practice.

Downing M, Bull C, Chavis T, Modrow M, McConnell G, Harr C JTCVS Open. 2024; 16:500-506.

PMID: 38204691 PMC: 10775069. DOI: 10.1016/j.xjon.2023.09.016.

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