Decrease of deep sternal surgical site infection rates after cardiac surgery by a comprehensive infection control program.
When we noticed an increasing incidence of deep sternal surgical site infections (DSSI), a bundle of interdisciplinary infection control measures was initiated in order to prevent further cases of DSSI. Adherence to infection control measures was re-inforced, which included (1) methicillin-resistant Staphylococcus aureus (MRSA) screening, (2) bacterial decolonisation measures, (3) hair clipping instead of shaving, (4) education, (5) good stewardship for antibiotic prophylaxis, (6) change of surgical gloves after sternotomy and after sternal wiring, (7) new bandage techniques, (8) leaving the wound primarily covered for at least 48 h. We checked for potential risk factors in a case-control study (120 patients each) by multivariate analysis. A significant decrease of DSSI from 3.61% (CI 95: 2.98-4.35) down to 1.83% (CI 95: 1.08-2.90) occurred. Independent significant risk factors for DSSI were age >68 years (OR=2.47; CI 95: 1.33-4.60), diabetes mellitus (OR=4.84; CI 95: 2.25-10.4), and intra-operative blood glucose level >8 mmol/l (OR=2.27; CI 95: 1.17-4.42). Protective factors were preoperative antibiotic prophylaxis (OR=0.31; CI 95: 0.13-0.70) and extubation on the day of surgery (OR=0.25; CI 95: 0.11-0.55). Close co-operation between clinical physicians and the infection control team significantly reduced the rate of DSSI. Thus, cardiac surgeons should know the local baseline DSSI rate, e.g. by surveillance, and should be aware of the risk factors for DSSI cases.
Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, D-30625 Hannover, Germany. Graf.Karolin@MH-Hannover.DE
Karolin
K
Graf
Dorit
D
Sohr
Axel
A
Haverich
Christian
C
Kühn
Petra
P
Gastmeier
Iris F
IF
Chaberny
D000367:Age Factors; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001786:Blood Glucose / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000209:etiology / Q000517:prevention & control; D005932:Gloves, Surgical; D019983:Guideline Adherence; D006204:Hair Removal; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D016017:Odds Ratio; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013997:Time Factors
D000891:Anti-Infective Agents, Local; D001786:Blood Glucose