title: Sternal surgical site infection prevention - is there any room for improvement?
abstract: OBJECTIVE
  The objectives of this multicenter study are to evaluate current clinical practices in cardiac surgery concerning the prevention and management of sternal wound infections, to identify room for improvement, and to support implementation of systematic measures.
  
  
  METHODS
  As a part of a campaign for infection prevention in cardiac surgery in Germany, a multiple-choice questionnaire with two main sections was developed and submitted to all cardiac surgery units in Germany (79). The project was realized in cooperation with the German Society for Thoracic and Cardiovascular Surgery, the BQS Institute for Quality and Patient Safety, and the National Reference Center for Nosocomial Infection Surveillance.
  
  
  RESULTS
  A representative number (54 of 79 or 68%) of German cardiac surgery centers participated in the survey, in which heterogeneous procedures and various standards for prevention were observed. Surveillance, standards, and advanced training regarding hygiene measures are present in almost all participating hospitals. Methicillin-resistant Streptococcus aureus (MRSA) screening is performed in 81.5% (44/54) of all participating departments. A little less than one-tenth (7.4%) perform decolonization measures on all patients, while 85.2% perform decolonization measures only on MRSA-positive patients. Application of perioperative antibiotic prophylaxis ranges from single-shot application to 3 days of treatment. Longer treatment is expensive and time-intensive, and also increases the risk of Clostridium difficile-associated diarrhea. Nearly three-quarters (70.4%) of all participating hospitals perform preoperative hair removal 1 day before surgery. Common techniques are clipping machines (53.7%), razors (40.7%), clipping machines and depilatory cream (1.9%), or depilatory cream only (1.9%). Remanent (37.0%) and non-remanent disinfectants (55.6%) are used for preoperative skin disinfection. The time of the first wound-dressing change varies from the day of surgery (1.9%) over the first (42.6%) or second (46.3%) day after surgery to up to 3 or more days after surgery (9.3%).
  
  
  CONCLUSIONS
  The results of the evaluation show that basic measures for infection prevention in cardiac surgery in Germany are well implemented. Nevertheless, a relevant heterogeneity in the use of special measures was observed, although research-based guidelines for infection prevention in surgery do exist and many studies have demonstrated the usefulness and feasibility of these measures.
authors.affiliation: German Society for Thoracic and Cardiovascular Surgery, Langenbeck-Virchow-Haus, Berlin, Germany. beckmann.a@me.com
authors.forename: Andreas
authors.initials: A
authors.lastname: Beckmann
authors.forename: Klaus
authors.initials: K
authors.lastname: Doebler
authors.forename: Elke
authors.initials: E
authors.lastname: Schaefer
authors.forename: Joachim
authors.initials: J
authors.lastname: Koetting
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.forename: Karolin
authors.initials: K
authors.lastname: Graf
mesh_terms: D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D001458:Bandages; D006348:Cardiac Surgical Procedures / Q000592:standards*; D004203:Disinfection / Q000379:methods; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006235:Hand Disinfection / Q000379:methods; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D008403:Mass Screening / Q000706:statistics & numerical data; D055624:Methicillin-Resistant Staphylococcus aureus; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data; D013203:Staphylococcal Infections / Q000175:diagnosis; D013249:Sternum / Q000382:microbiology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*