title: Outcomes following the implementation of a quality control campaign to decrease sternal wound infections after coronary artery by-pass grafting.
abstract: BACKGROUND
  Coronary artery by-pass grafting (CABG) remains the optimal strategy in achieving complete revascularization in patients with complex coronary artery disease. However, sternal wound infections (SWI), especially deep SWI are potentially severe complications to the surgery. At the department of cardiothoracic surgery in Uppsala University Hospital a gradual increase in all types of SWI occurred, which peaked in 2009. This prompted an in-depth revision of the whole surgical process. To monitor the frequency of post-operative infections all patients receive a questionnaire that enquires whether any treatment for wound infection has been carried out.
  
  
  METHODS
  All patients operated with isolated CABG between start of 2006 and end of 2012 were included in the study. 1515 of 1642 patients answered and returned the questionnaire (92.3 %). The study period is divided into the time before the intervention program was implemented (2006-early 2010) and the time after the intervention (early 2010- end 2012). To assess whether potential differences in frequency of SWI were a consequence of change in the characteristics of the patient population rather than an effect of the intervention a retrospective assessment of medical records was performed, where multiple of the most known risk factors for developing SWI were studied.
  
  
  RESULTS
  We noticed a clear decrease in the frequency of SWI after the intervention. This was not a consequence of a healthier population.
  
  
  CONCLUSIONS
  Our results from implementing the intervention program are positive in that they reduce the number of SWI. As several changes in the perioperative care were introduced simultaneously we cannot deduce which is the most effective.
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, 751 85, Uppsala, Sweden. rickard.lindblom@ki.se.
authors.forename: Rickard P F
authors.initials: RP
authors.lastname: Lindblom
authors.affiliation: Department of Medical Sciences, Unit for Clinical Microbiology and Infectious Medicine, Uppsala University, Uppsala, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Lytsy
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, 751 85, Uppsala, Sweden.
authors.forename: Camilla
authors.initials: C
authors.lastname: Sandström
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, 751 85, Uppsala, Sweden.
authors.forename: Nadjira
authors.initials: N
authors.lastname: Ligata
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, 751 85, Uppsala, Sweden.
authors.forename: Beata
authors.initials: B
authors.lastname: Larsson
authors.affiliation: Department of Medical Sciences, Unit for Clinical Microbiology and Infectious Medicine, Uppsala University, Uppsala, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Ransjö
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, 751 85, Uppsala, Sweden.|Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Christine Leo
authors.initials: CL
authors.lastname: Swenne
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011786:Quality Control; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects* / Q000592:standards; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome