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Erschienen in: Pediatric Cardiology 7/2020

18.06.2020 | Original Article

A Quality Improvement Initiative to Reduce Surgical Site Infections in Patients Undergoing Delayed Sternal Closure After Pediatric Cardiac Surgery

verfasst von: Prashant Jha, Cathy S. Woodward, Heather Gardner, Clinton Pietz, S. Adil Husain

Erschienen in: Pediatric Cardiology | Ausgabe 7/2020

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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.
Literatur
1.
Zurück zum Zitat Furnary AP, Magovern JA, Simpson KA, Magovern GJ (1992) Prolonged open sternotomy and delayed sternal closure after cardiac operations. Ann Thorac Surg 54(2):233–239CrossRef Furnary AP, Magovern JA, Simpson KA, Magovern GJ (1992) Prolonged open sternotomy and delayed sternal closure after cardiac operations. Ann Thorac Surg 54(2):233–239CrossRef
2.
Zurück zum Zitat Sarzaeeem MR, Jebelli M, Amidshahi A et al (2011) Analysis of different aspects of delayed sternal closure in pediatrics and adults: a review. Iran J Cardiac Surg 2011:34–45 Sarzaeeem MR, Jebelli M, Amidshahi A et al (2011) Analysis of different aspects of delayed sternal closure in pediatrics and adults: a review. Iran J Cardiac Surg 2011:34–45
3.
Zurück zum Zitat Adler AL, Smith J, Permut LC et al (2014) Significance of positive mediastinal cultures in pediatric cardiovascular surgical procedure patients undergoing delayed sternal closure. Ann Thorac Surg 98(2):685–690CrossRef Adler AL, Smith J, Permut LC et al (2014) Significance of positive mediastinal cultures in pediatric cardiovascular surgical procedure patients undergoing delayed sternal closure. Ann Thorac Surg 98(2):685–690CrossRef
4.
Zurück zum Zitat Woodward CS, Son M, Taylor R et al (2012) Prevention of sternal wound infection in pediatric cardiac surgery: a protocolized approach. World J Pediatr Congenit Heart Surg 3(4):463–469CrossRef Woodward CS, Son M, Taylor R et al (2012) Prevention of sternal wound infection in pediatric cardiac surgery: a protocolized approach. World J Pediatr Congenit Heart Surg 3(4):463–469CrossRef
5.
Zurück zum Zitat Harder EE, Gaies MG, Yu S et al (2013) Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure. J Thorac Cardiovasc Surg 146(2):326–333CrossRef Harder EE, Gaies MG, Yu S et al (2013) Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure. J Thorac Cardiovasc Surg 146(2):326–333CrossRef
6.
Zurück zum Zitat Bowman ME, Rebeyka IM, Ross DB et al (2013) Risk factors for surgical site infection after delayed sternal closure. Am J Infect Control 41:464–465CrossRef Bowman ME, Rebeyka IM, Ross DB et al (2013) Risk factors for surgical site infection after delayed sternal closure. Am J Infect Control 41:464–465CrossRef
7.
Zurück zum Zitat Sochet AA, Cartron AM, Nyhan A et al (2017) surgical site infection after pediatric cardiothoracic surgery. World J Pediatr Congenit Heart Surg 8(1):7–12CrossRef Sochet AA, Cartron AM, Nyhan A et al (2017) surgical site infection after pediatric cardiothoracic surgery. World J Pediatr Congenit Heart Surg 8(1):7–12CrossRef
8.
Zurück zum Zitat Delgado-Corcoran C, Van Dorn CS, Pribble C et al (2017) Reducing pediatric sternal wound infections: a quality improvement project. Pediatr Crit Care Med 18(5):461–468CrossRefPubMed Delgado-Corcoran C, Van Dorn CS, Pribble C et al (2017) Reducing pediatric sternal wound infections: a quality improvement project. Pediatr Crit Care Med 18(5):461–468CrossRefPubMed
9.
Zurück zum Zitat Hodge AB, Thornton BA, Gajarski R et al (2019) Quality improvement project in congenital cardiothoracic surgery patients: reducing surgical site infections. Pediatr Qual Saf 4(4):e188CrossRefPubMed Hodge AB, Thornton BA, Gajarski R et al (2019) Quality improvement project in congenital cardiothoracic surgery patients: reducing surgical site infections. Pediatr Qual Saf 4(4):e188CrossRefPubMed
10.
Zurück zum Zitat Schaffzin JK, Harte L, Marquette S et al (2015) Surgical site infection reduction by the solutions for patient safety hospital engagement network. Pediatrics 136(5):e1353–e1360CrossRef Schaffzin JK, Harte L, Marquette S et al (2015) Surgical site infection reduction by the solutions for patient safety hospital engagement network. Pediatrics 136(5):e1353–e1360CrossRef
11.
Zurück zum Zitat Woodward C, Taylor R, Son M et al (2017) Multicenter quality improvement project to prevent sternal wound infections in pediatric cardiac surgery patients. World J Pediatr Congenit Heart Surg 8(4):453–459CrossRef Woodward C, Taylor R, Son M et al (2017) Multicenter quality improvement project to prevent sternal wound infections in pediatric cardiac surgery patients. World J Pediatr Congenit Heart Surg 8(4):453–459CrossRef
12.
Zurück zum Zitat Nelson-McMillan K, Hornik CP, He X et al (2016) Delayed sternal closure in infant heart surgery—the importance of where and when: an analysis of the STS congenital heart surgery database. Ann Thorac Surg 102(5):1565–1572CrossRef Nelson-McMillan K, Hornik CP, He X et al (2016) Delayed sternal closure in infant heart surgery—the importance of where and when: an analysis of the STS congenital heart surgery database. Ann Thorac Surg 102(5):1565–1572CrossRef
13.
Zurück zum Zitat Silvetti S, Landoni G, Castagnola E et al (2020) Antibiotic management for delayed sternal closure following pediatric cardiac surgery: a systematic review of recent literature. J Cardiothorac Vasc Anesth. 34(5):1333–1340CrossRef Silvetti S, Landoni G, Castagnola E et al (2020) Antibiotic management for delayed sternal closure following pediatric cardiac surgery: a systematic review of recent literature. J Cardiothorac Vasc Anesth. 34(5):1333–1340CrossRef
14.
Zurück zum Zitat Bratzler DW, Dellinger EP, Olsen KM et al (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 70:195–283CrossRef Bratzler DW, Dellinger EP, Olsen KM et al (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 70:195–283CrossRef
15.
Zurück zum Zitat Anderson DJ, Podgorny K, Berrıos-Torres SI et al (2014) Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35:605–627CrossRefPubMed Anderson DJ, Podgorny K, Berrıos-Torres SI et al (2014) Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35:605–627CrossRefPubMed
16.
Zurück zum Zitat Engelman R, Shahian D, Shemin R et al (2007) The Society of Thoracic Surgeons Practice Guideline Series: antibiotic prophylaxis in cardiac surgery, Part II: antibiotic choice. Ann Thorac Surg 83:1569–1576CrossRef Engelman R, Shahian D, Shemin R et al (2007) The Society of Thoracic Surgeons Practice Guideline Series: antibiotic prophylaxis in cardiac surgery, Part II: antibiotic choice. Ann Thorac Surg 83:1569–1576CrossRef
17.
Zurück zum Zitat Eckardt JL, Wanek MR, Udeh CI et al (2018) Evaluation of prophylactic antibiotic use for delayed sternal closure after cardiothoracic operation. Ann Thorac Surg 105(5):1365–1369CrossRef Eckardt JL, Wanek MR, Udeh CI et al (2018) Evaluation of prophylactic antibiotic use for delayed sternal closure after cardiothoracic operation. Ann Thorac Surg 105(5):1365–1369CrossRef
Metadaten
Titel
A Quality Improvement Initiative to Reduce Surgical Site Infections in Patients Undergoing Delayed Sternal Closure After Pediatric Cardiac Surgery
verfasst von
Prashant Jha
Cathy S. Woodward
Heather Gardner
Clinton Pietz
S. Adil Husain
Publikationsdatum
18.06.2020
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 7/2020
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-020-02396-x

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