title: Reducing Pediatric Sternal Wound Infections: A Quality Improvement Project.
abstract: OBJECTIVE
  To evaluate whether a quality improvement intervention reduces sternal wound infection rates in children after cardiac surgery.
  
  
  METHODS
  This is a pre- and postintervention quality improvement study.
  
  
  METHODS
  A 16-bed cardiac ICU in a university-affiliated pediatric tertiary care children's hospital.
  
  
  METHODS
  All patients undergoing cardiac surgery via median sternotomy from January 2010 to December 2014 are included. The sternal wound infection rates for primary closure and delayed sternal closure are reported per 100 sternotomies. The hospital-acquired infection records were used to identify preintervention cases, while postintervention cases were collected prospectively.
  
  
  METHODS
  Implementation of a sternal wound prevention bundle during the preoperative, intraoperative, and postoperative periods for cardiac surgical cases.
  
  
  RESULTS
  During the preintervention period, 32 patients (3.8%) developed sternal wound infection, whereas only 19 (2.1%) developed sternal wound infection during the postintervention period (p = 0.04). The rates of sternal wound infection following primary closure were not significantly different pre- and postintervention (2.4% vs 1.6%; p = 0.35). However, patients with delayed sternal closure had significantly lower postintervention infection rates (10.6% vs 3.9%; p = 0.02).
  
  
  CONCLUSIONS
  Implementation of a sternal wound prevention bundle during the perioperative period was associated with lower sternal wound infection rates in surgeries with delayed sternal closure.
authors.affiliation: 1Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT. 2Divisions of Pediatric Critical Care Medicine and Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN. 3Division of Infectious Disease, Department of Pediatrics, University of Utah, Salt Lake City, UT. 4Pediatric Intensive Care Department, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT. 5Information Technology Department, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT. 6Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT.
authors.forename: Claudia
authors.initials: C
authors.lastname: Delgado-Corcoran
authors.forename: Charlotte S
authors.initials: CS
authors.lastname: Van Dorn
authors.forename: Charles
authors.initials: C
authors.lastname: Pribble
authors.forename: Emily A
authors.initials: EA
authors.lastname: Thorell
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pavia
authors.forename: Camille
authors.initials: C
authors.lastname: Ward
authors.forename: Randall
authors.initials: R
authors.lastname: Smout
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
authors.forename: Phillip T
authors.initials: PT
authors.lastname: Burch
mesh_terms: D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D064872:Patient Care Bundles; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D056346:Sternotomy; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome