title: Implementing evidence-based practice findings to decrease postoperative sternal wound infections following open heart surgery.
abstract: Sternal wound infections following open heart surgery are an infrequent occurrence but can have significant impact on patient morbidity, length of stay, and cost of care. The objective of this project initiative was to decrease the incidence of sternal wound infections by examining and changing current practice in the preoperative and postoperative management of patients undergoing open heart surgery. Following a literature review of interdisciplinary best practices, process teams were formed to evaluate our own patient cohort with documented infection. Five key areas were addressed: (1) preoperative skin preparation, (2) antibiotic prophylaxis, (3) blood glucose control, (4) wound care management, and (5) hand hygiene. A retrospective chart review of patients with documented sternal wound infections status post-mediastinal open heart surgery revealed that the average postoperative glucose was 201 mg/dL. An inquiry of practice variations determined the absence of a common provider and causative organism. A change model guided project initiatives and sustainability of new behaviors and practice. Each element of the project initiative had defined outcome measures. Staff nurses participated in peer education and outcome data collection. Following the implementation of evidence based practice changes, a linear decrease in sternal wound infections was documented. Nurses play a critical role in identifying, orchestrating, and evaluating change efforts in clinical practice. Outcomes are enhanced when nurses collaborate with all stakeholders in the practice improvement initiative.
authors.affiliation: Banner Good Samaritan Medical Center, Phoenix, Arizona 85006, USA. haycock@bannerhealth.com
authors.forename: Camille
authors.initials: C
authors.lastname: Haycock
authors.forename: Craig
authors.initials: C
authors.lastname: Laser
authors.forename: Jennifer
authors.initials: J
authors.lastname: Keuth
authors.forename: Kerry
authors.initials: K
authors.lastname: Montefour
authors.forename: Melissa
authors.initials: M
authors.lastname: Wilson
authors.forename: Kerry
authors.initials: K
authors.lastname: Austin
authors.forename: Charmaine
authors.initials: C
authors.lastname: Coulen
authors.forename: Deborah
authors.initials: D
authors.lastname: Boyle
mesh_terms: D019072:Antibiotic Prophylaxis; D001130:Arizona / Q000453:epidemiology; D019985:Benchmarking / Q000458:organization & administration; D001786:Blood Glucose / Q000032:analysis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D006235:Hand Disinfection; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D017146:Models, Organizational; D009017:Morbidity; D024802:Nurse's Role; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D017592:Skin Care; D013249:Sternum; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D001786:Blood Glucose