title: Implementation of bundled interventions greatly decreases deep sternal wound infection following cardiovascular surgery.
abstract: OBJECTIVE
  Surgical site infection (SSI), particularly deep sternal wound infection (DSWI), is a serious complication after cardiovascular surgery because of its high mortality rate. We evaluated the effectiveness of an SSI bundle to reduce DSWI and identify the risk factors for DSWI.
  
  
  METHODS
  During the period January 2004 to February 2012, 1374 consecutive patients undergoing cardiovascular surgery via sternotomy were included. The cohort was separated into periods from January 2004 through February 2007 (period I, 682 patients) and March 2007 through February 2012 (period II, 692 patients). During period II, all preventive measures for DSWI were completed as an SSI bundle. We compared the DSWI rate between the 2 periods. Univariate and multivariate analyses were performed for the entire period to identify the risk factors for DSWI.
  
  
  RESULTS
  DSWI occurred in 13 patients (1.9%) during period I and in 1 patient (0.14%) during period II. The DSWI rate during period II was significantly decreased by 93%, compared with period I (P=.001). Independent risk factors for DSWI included obesity (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.00-11.75; P=.049), the use of 4 sternal wires (OR, 8.2; 95% CI, 1.39-48.14; P=.020), long operative time (OR, 4.4; 95% CI, 1.20-16.23; P=.026), and postoperative renal failure (OR, 9.0; 95% CI, 2.44-33.30; P=.001).
  
  
  CONCLUSIONS
  Complete implementation of simple multidisciplinary prevention measures as a bundle can greatly decrease the incidence of DSWI.
authors.affiliation: Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan. Electronic address: medical.miyahara@nifty.com.
authors.forename: Ken
authors.initials: K
authors.lastname: Miyahara
authors.affiliation: Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Matsuura
authors.affiliation: Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Takemura
authors.affiliation: Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Mizutani
authors.affiliation: Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan.
authors.forename: Shunei
authors.initials: S
authors.lastname: Saito
authors.affiliation: Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Toyama
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D064872:Patient Care Bundles; D010348:Patient Care Team; D011314:Preventive Health Services; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*