Impact of a patient care pathway protocol on surgical site infection rates in cardiothoracic surgery patients.
BACKGROUND
We hypothesized that implementing a quality care initiative, including peri-incisional antibiotic administration, tight blood glucose control, and hair removal with clippers would reduce surgical site infection (SSI) rates in patients undergoing coronary artery bypass grafting (CABG), with or without valve replacement.


METHODS
Patients undergoing CABG were studied retrospectively, before (n = 808) and after (n = 674) instituting a patient care protocol. The pathway included peri-incisional antibiotics, tight glucose control (80 mg/dL-110 mg/dL) throughout intensive care unit (ICU) stays, and hair removal with clippers.


RESULTS
SSIs were significantly decreased in the experimental group (1.5%), compared with the control group (3.5%), (P = .001, odds ratio [OR] = .21). Significant independent predictors of infection included diabetes mellitus (P = .001, OR = 4.71), Nosocomial Infection Surveillance System (NNIS) wound class II (P = .044, OR = 2.07), and female gender (P = .001, OR = 2.83).


CONCLUSIONS
Protocols implementing timely perioperative antibiotics, tight blood glucose control, and avoidance of shaving decrease SSI rates in CABG patients.
Trussell
Joshua
J
Department of Surgery, Phoenix Integrated Surgical Residency (PISR), Banner Good Samaritan Medical Center, 925 E. McDowell Rd., Phoenix, AZ 85006, USA.
Gerkin
Richard
R
Coates
Brian
B
Brandenberger
Jared
J
Tibi
Pierre
P
Keuth
Jennifer
J
Montefour
Kerry
K
Salisbury
Helen
H
Ferrara
John
J
D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000592:standards; D001786:Blood Glucose / Q000378:metabolism; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D005791:Patient Care / Q000592:standards*; D011300:Preoperative Care / Q000379:methods; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
D001786:Blood Glucose