Impact of a patient care pathway protocol on surgical site infection rates in cardiothoracic surgery patients (original) (raw)
Journal of International Medical Research
Objective: Surgical site infection (SSI) is a serious complication after coronary artery bypass grafting (CABG). This study was performed to evaluate evidence-based practice and structured problem-solving to reduce SSI after CABG. Methods: An infection control strategy including supervised chlorhexidine gluconate (CHG) showers was implemented from January 2017 to March 2018 for 119 patients undergoing CABG. The controls comprised 244 patients who underwent CABG from 2014 to 2016. Risk factors for SSI were identified, and a problem-focused strategy was used to control SSI. Propensity score matching was used to study the effect of CHG showers on SSI. Results: SSI occurred in 25 patients (10.25%) in the control group, and the significant risk factors were the postoperative blood glucose level, transfer from an outside hospital, emergency operation, redo sternotomy, a higher American Society of Anesthesiologists score, and the duration
Survey of Preoperative Infection Prevention for Coronary Artery Bypass Graft Procedures
Infection Control & Hospital Epidemiology, 2014
Approximately 400,000 coronary artery bypass graft (CABG) procedures are performed annually in the United States. 1 Surgical site infections (SSI) complicate 3-5% of CABG procedures and result insignificant attributable mortality. 2-4 Studies show that surgical preparation with chlorhexidine is more effective than povidone-iodine in reducing bacterial colony counts and lowering SSI. 5-8 In addition to surgical preparation, the use of clippers or a chemical depilatory for hair removal has a lower SSI rate than the use of razors. 8,9 To better understand compliance with established standards of care, we conducted a survey of pre-operative surgical practices used prior to isolated CABG surgery among hospitals in California. We utilized the survey data to calculate an estimate of excess infections and mortality from non-compliance with practice standards. Methods We developed a web-based survey for all 120 California medical centers that perform CABG surgery. The survey asked about pre-operative bathing, surgical preparation, dressing management, and antibiotic prophylaxis for isolated CABG. Questions relating to surgical preparation and hair removal included: i) what do you most commonly use for surgical preparation, usually given in the operating room immediately prior to CABG; ii) what method is most commonly used for hair removal prior to CABG, iii) who receives preoperative bathing, iv) what is the location of the pre-operative bath, and v) what is used for pre-operative bathing. We collected descriptive information on individual hospitals,
Assessment of Cardiovascular Surgical Infection Prophylaxis in a Lebanese Hospital
Journal of Pharmacy and Pharmacology 3 (2015) 479-488, 2015
The appropriate use of antibiotics prophylaxis reduces the incidence of surgical site infections. Despite advances in antiseptic measures, antibiotics, and preoperative precautions, infections are common complications from surgeries. This study was conducted to assess the appropriateness of the prescription of antibiotics prophylaxis prior to cardiac surgery among hospitalized patients in the geographic area of Lebanon. This was a retrospective, observational, single center study conducted at a public Lebanese teaching hospital from February till April 2014. Data were collected from computerized data bases for hospitalized patients who did cardiac surgeries from January 2010 till December 2013. Patients above eighteen years old undergoing CABG (coronary artery bypass graft), valve surgery, or both were eligible for study enrollment. Excluded were patients younger than eighteen years of age, prior intake of antibiotics, or had another concomitant surgery with the cardiac. Consistency with the guidelines was evaluated for appropriate route of administration, choice, preoperative timing, duration, dosing, and redosing of antibiotics. The IRB (Institutional Review Board) approved the study design. Data were analyzed by the SPSS version 20.0 and presented as frequency/percentage and mean ± SD (standard deviation). A total of 3,000 patients were initially screened where only 245 patients met the inclusion criteria. Baseline age of the participants was 58.91 ± 13.65 years (mean ± standard deviation SD), and a body mass index of 28.19 ± 5.19 Kg/m 2. The enrolled participants were on different intravenous antibiotic regimens, where 188 (76.7%) patients were on vancomycin and ceftriaxone, 15 (6.1%) on vancomycin and cefuroxime, 13 (5.3%) on ceftriaxone, 12 (4.9%) on vancomycin, 6 (2.4%) on cefuroxime, 2 (0.8%) on clindamycin), and the others were on combination of gentamicin and a cephalosporin. Only twelve (4.9%) from the enrolled patients were consistent with the treatment guidelines regarding the choice of the antibiotic. For those patients who were given the appropriate antibiotics, proper dose was found in only seven patients (58.7%). Five patients out of 254 (2%) required redosing where four were given the appropriate doses. As for preoperative timing it was appropriate for all of those cases (i.e. within 120 minutes of incision for vancomycin and within 60 minutes for cefuroxime and clindamycin). Prophylaxis was extended beyond one day in 173 patients (70.61%) and the average duration was 2.8531 days ± 2.07514. This study demonstrates that in cardiac surgery, the optimal choice of antibiotics is seldom administered, duration of prophylaxis is excessively long, and the preoperative dose timing is rarely employed. More education and communication are required to improve these practices to reduce risks of surgical site infection, prevent resistance, and limit costs potentially associated with antibiotic misuse. The role of clinical pharmacist may facilitate this process across all surgical disciplines through interventions that should be implemented to optimize the perioperative antibiotic prophylaxis in procedures.
Journal of Clinical Trials in Cardiology, 2018
Objective: To determine the incidence and predictor of postoperative wound infection in patients underwent coronary artery bypass grafting (CPB). Methods: This was a prospective comparative study of 577 patients who underwent cardiac surgery with (CPB) was conducted at cardiac surgery department of Punjab Institute of cardiology, Lahore from 1st March 2012 to 31st March 2017. Consecutive patients undergoing elective and isolated CABG, both genders age ≥20 years, with normal ejection fraction were included in the study Results: Out of 577 patients of which 166(87.83%) were male while 23(12.16%) were female. The mean age of the patient was 53.23 ± 8.43. Incidence of post-operative wound infection in patients underwent coronary artery bypass grafting (CPB) was 73(12.65%). Common co morbid conditions were hypertension 50%, diabetes mellitus (43.5%), smoking (31.1%), hyperlipidemia (20.3%), prior of stoke (12.2%), Prior Surgery (6.8%) and prior renal failure (4.1%), mean CPB time (61.69 ± 32.27), ICU stay 976.03 ± 31.93), mean Cross clamp time(25.27 ± 19.17mg/dl) and Hospital stay (10.16 ± 5.6 day) were more in WI group. Themortality was found to be high in WI group (23.3%). Logistic regression showed that significantly predicted of the post-operative WI were elder age,diabetes mellitus, smoking, family history of IHD, hyperlipidemia, cardiopulmonary bypass time, ICU stay, hospital stay. Conclusion: We can conclude that wound infected patients are at significantly greater risk of incidence, morbidity and mortality after cardiac surgery.
Surgical Site Infection Prevention Bundle in Cardiac Surgery
Arquivos Brasileiros de Cardiologia, 2019
Background: Surgical site infections (SSI) are among the most prevalent infections in healthcare institutions, attributing a risk of death which varies from 33% to 77% and a 2-to 11-fold increase in risk of death. Patients submitted to cardiac surgery are more susceptible to SSI, accounting for 3.5% to 21% of SSI. The mortality rate attributable to these causes is as high as 25%. Prevention of SSI in cardiac surgery is based on a bundle of preventive measures, which focus on modifiable risks. Objective: The objective of this study was to identify SSI risk factors in clean cardiac surgery. Methods: A retrospective cohort study analyzed 1,846 medical records from patients who underwent clean cardiac surgery. Fisher's exact test was used for bivariate comparison, and Poisson regression was used for independent analysis of SSI risk, considering a significance level of p < 0.05. Results: The results of the study comprised a multivariate analysis. The variables that were associated with the diagnosis of SSI were: surgical risk index (
Surgical site infections in cardiac surgery: an 11-year perspective
American Journal of Infection Control, 2004
Background: A surgical site infection (SSI) develops in 2% to 5% of patients undergoing operation. We report SSI surveillance at Baystate Medical Center, Springfield, Mass, in coronary artery bypass operation between 1991 and 2001, and demonstrate a substantial decline in SSI rates accomplished with use of multiple intervention strategies.
2017
BACKGROUND: There is a conflict evidence about the association of using bilateral internal mammary artery (BIMA) grafting in diabetics undergoing coronary artery bypass grafting (CABG) surgery and increased risk of contracting surgical site infection. The direct impact of the diabetics glycemic control status and using the optimal grafting method on surgical site infection is still not conclusive in literature. The aim of the study is to evaluate the impact of Bilateral internal mammary artery grafting in diabetic patients, the diagnosis of diabetes mellitus, and its glycemic control status on different kinds of nosocomial infections. The assumption was made that those exposures associated with higher risk of surgical site infection, urinary tract infection, blood stream infection and pneumonia. METHOD: A retrospective cohort is conducted by utilizing Nationwide Inpatient Sample (NIS) data from the Agency of Healthcare Research and Quality (AHRQ). All patients who were admitted to coronary artery bypass grafting (CABG) surgery were retrieved from 2007 to 2012 and grouped based on the exposures of the study. RESULTS: The total sample of the study was 286,487 patients underwent CABG surgery. There were 122,642 (42.81%) patients diagnosed with Diabetes Mellitus, of whom 18,065 (14.73%) had uncontrolled hyperglycemia, 3,700 (3.01%) received Bilateral (IMA) and 103,577 (84.45%) unilateral or single (IMA) grafting method. The study population was predominantly white (79.78%) and male (72.08%) with an average age of 66 (SD ±10.89) old. About 215,740 (75.31%) of patients had developed nosocomial pneumonia, 16,667 (5.82%) urinary tract infections (UTIs), 9,442 (3.3%) sepsis or bloodstream infection (BSIs), and 5,302 (1.85%) surgical site infection (SSIs in overall sample population. vi Among diabetic patients, there was no significant difference in comparing BIMA versus SIMA for surgical site infection (SSI) (p-value=0.2491) and blood stream infections (BSI) (p-value=0.6630). The results have also indicated that UTIs (4.2% vs. 5.5%; p-value=0.0005) was significantly lower with BIMA grafting method. However, results did not meet the hypothesis assumption regarding Pneumonias rate (76.8% vs. 70.5%; p-value < 0.0001) and was significantly higher with BIMA compared to SIMA grafting method. Multivariable analysis showed inconsistent result and confirmed that BIMA grafting predicts higher odd of BSI by 44.6% in diabetic, compared to SIMA grafting (OR: 1.446; 95% CI: 1.22-1.71; p<.0001). The cross unadjusted baseline results for all nosocomial infections were significantly lower in diabetic patients compared to non-diabetic; Except for UTI was significantly higher by the presence of diabetes in BIMA grafting population (n=10,223) (4.2% vs. 3.39%; p-value= 0.0393). Multivariable analysis has confirmed that Diabetes Miletus increase the risk of UTI by 21.7% in BIMA population (OR: 1.217; 95% CI: 1.21-1.22; p<.0001). The bivariate analysis results indicated that nosocomial infections were significantly higher in a diabetic with uncontrolled HbA1c compared to those with controlled diabetes. Except for nosocomial pneumonia. Adjusted results showed that uncontrolled hyperglycemia in a diabetic increase risk of UTI by 20% in overall and SIMA population. Uncontrolled hyperglycemia increase risk of SSI by 52% and UTI by 104% in diabetic undergoing BIMA grafting (
for the Healthcare Infection Control Practices Advisory Committee IMPORTANCE The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies.