Decrease of deep sternal surgical site infection rates after cardiac surgery by a comprehensive infection control program

Autor: Iris F. Chaberny, Christian Kühn, Axel Haverich, Petra Gastmeier, Dorit Sohr, Karolin Graf
Rok vydání: 2009
Předmět:
Blood Glucose
Methicillin-Resistant Staphylococcus aureus
Pulmonary and Respiratory Medicine
Sternum
medicine.medical_specialty
Time Factors
Hair Removal
medicine.disease_cause
Risk Assessment
Preoperative care
Diabetes Complications
Risk Factors
Diabetes mellitus
Odds Ratio
medicine
Humans
Surgical Wound Infection
Infection control
Gloves
Surgical
Prospective Studies
Cardiac Surgical Procedures
Antibiotic prophylaxis
Aged
Retrospective Studies
Patient Care Team
Infection Control
business.industry
Incidence
Incidence (epidemiology)
Age Factors
Antibiotic Prophylaxis
medicine.disease
Methicillin-resistant Staphylococcus aureus
Surgery
Cardiac surgery
Case-Control Studies
Practice Guidelines as Topic
Anti-Infective Agents
Local
Guideline Adherence
Cardiology and Cardiovascular Medicine
business
Bandage
Program Evaluation
Zdroj: Interactive CardioVascular and Thoracic Surgery. 9:282-286
ISSN: 1569-9293
DOI: 10.1510/icvts.2009.205286
Popis: 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.
Databáze: OpenAIRE
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