A Quality Improvement Initiative to Reduce Surgical Site Infections in Patients Undergoing Delayed Sternal Closure After
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ORIGINAL ARTICLE
A Quality Improvement Initiative to Reduce Surgical Site Infections in Patients Undergoing Delayed Sternal Closure After Pediatric Cardiac Surgery Prashant Jha1,2 · Cathy S. Woodward3,4 · Heather Gardner3,4 · Clinton Pietz3,4 · S. Adil Husain5 Received: 28 March 2020 / Accepted: 12 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Sternal wound infections (SWI) in delayed sternal closure (DSC) patients are a healthcare burden after congenital heart surgery. There are no guidelines specific for pediatric DSC patients to prevent this costly complication. The hypothesis was that the modifications to a bundled approach for DSC patients would decrease the SWI rate. For this prospective cohort study, DSC patients were postoperatively admitted to a pediatric cardiac care unit from February 2017 to January 2018. Using a modified protocol for prevention of SWI, the infection rates pre- and post-modified protocol were compared. The primary outcome measure was SWI. Secondary outcome measures were compliance with modifications. Retrospective review of cases in pre-protocol modification era from January 1, 2014 to December 31, 2016 showed 377 pediatric cardiopulmonary bypass cases and 39 (10.4%) underwent DSC. During the post-protocol modification era, there were 129 cardiopulmonary bypass cases and 17 (13%) DSC cases. The SWI rate in DSC were 7.7% and 0% for pre-intervention and post-intervention, respectively (p = 0.52). The Bayesian confidence interval with Jeffreys prior gives a 95% confidence interval of 1.5% to 18.3% for pre-intervention and 0 to 13.5% for post-intervention. Compliance with the protocol bundle during the post protocol era was 93–100%. Although preliminary results are not statistically significant due to cohort size, the economic burden and increased LOS for each SWI is clinically significant. The early results of reduced infections for DSC patients using a modified bundle approach appear promising. Continued study and a multicenter project would be beneficial. Keywords Delayed sternal closure · Sternal wound infection · Surgical site infection · Mediastinitis · Bundled approach · Quality improvement · Patient safety Abbreviations DSC Delayed sternal closure SWI Sternal wound infection STS Society of thoracic surgery Meeting presentation: Cardiology 2018: 21st Annual Update on Pediatric and Congenital Cardiovascular Disease; Scottsdale, AZ, USA, 02/22/2018
SCIP Surgical Care Improvement Project SSI Surgical site infection PCCU Pediatric cardiac care unit CHG Chlorhexidine Gluconate SWIP Sternal wound infection prevention OR Operating room 1
* Prashant Jha [email protected]
Division of Critical Care, Department of Pediatrics, Children’s Hospital of Nevada, University Medical Center, 1800 W Charleston Blvd, Las Vegas, NV 89128, USA
2
Cathy S. Woodward [email protected]
Department of Pediatrics, University of Nevada at Las Vegas, Las Vegas, NV, USA
3
Heather Gardner [email protected]
Pediatric Services, Unive
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