Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections teamCentral MessagePerspective
Objectives: The majority of studies examining deep sternal wound infection (DSWI) prevention focus on ameliorating 1 variable at a time. There is a paucity of data regarding the synergistic effects of combining clinical and environmental interventions. This article describes an interdisciplinary, mu...
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Elsevier
2023-06-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723001189 |
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| author | Maren Downing, MEng Michael Modrow, PA-C Kelly A. Thompson-Brazill, DNP J. Erin Ledford, PharmD Charles D. Harr, MD, MBA Judson B. Williams, MD, MHS |
| author_facet | Maren Downing, MEng Michael Modrow, PA-C Kelly A. Thompson-Brazill, DNP J. Erin Ledford, PharmD Charles D. Harr, MD, MBA Judson B. Williams, MD, MHS |
| author_sort | Maren Downing, MEng |
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| description | Objectives: The majority of studies examining deep sternal wound infection (DSWI) prevention focus on ameliorating 1 variable at a time. There is a paucity of data regarding the synergistic effects of combining clinical and environmental interventions. This article describes an interdisciplinary, multimodal approach to eliminate DSWIs at a large community hospital. Methods: We developed a robust, multidisciplinary infection prevention team to evaluate and act in all phases of perioperative care to achieve a cardiac surgery DSWI rate of 0, named: the I hate infections team. The team identified opportunities for improved care and best practices and implemented changes on an ongoing basis. Results: Patient-related interventions consisted of preoperative methicillin-resistant Staphylococcus aureus identification, individualized perioperative antibiotics, antimicrobial dosing strategies, and maintenance of normothermia. Operative-related interventions involved glycemic control, sternal adhesives, medications and hemostasis, rigid sternal fixation for high-risk patients, chlorhexidine gluconate dressings over invasive lines, and use of disposable health care equipment. Environment-related interventions included optimizing operating room ventilation and terminal cleaning, reducing airborne particle counts, and decreasing foot traffic. Together, these interventions reduced the DSWI incidence from 1.6% preintervention to 0% for 12 consecutive months after full bundle implementation. Conclusions: A multidisciplinary team focused on eliminating DSWI identified known risk factors and implemented evidence-based interventions in each phase of care to ameliorate risk. Although the influence of each individual intervention on DSWI remains unknown, use of the bundled infection prevention approach reduced the incidence to 0 for the first 12 months after implementation. |
| format | Article |
| id | doaj-art-cf3d42c15f5a4eceaf0e03fbb823605a |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-cf3d42c15f5a4eceaf0e03fbb823605a2025-08-20T03:38:26ZengElsevierJTCVS Techniques2666-25072023-06-01199310310.1016/j.xjtc.2023.03.019Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections teamCentral MessagePerspectiveMaren Downing, MEng0Michael Modrow, PA-C1Kelly A. Thompson-Brazill, DNP2J. Erin Ledford, PharmD3Charles D. Harr, MD, MBA4Judson B. Williams, MD, MHS5WakeMed Health and Hospitals, Raleigh, NC; Campbell University School of Osteopathic Medicine, Lillington, NC; Address for reprints: Maren Downing, MEng, Campbell University School of Osteopathic Medicine, Leon Levine Hall of Medical Sciences, 4360 US-421, Lillington, NC 27546.WakeMed Health and Hospitals, Raleigh, NC; Department of Cardiovascular and Thoracic Surgery, WakeMed Heart and Vascular, Raleigh, NCWakeMed Health and Hospitals, Raleigh, NC; Department of Cardiovascular and Thoracic Surgery, WakeMed Heart and Vascular, Raleigh, NCWakeMed Health and Hospitals, Raleigh, NC; Department of Cardiovascular and Thoracic Surgery, WakeMed Heart and Vascular, Raleigh, NCWakeMed Health and Hospitals, Raleigh, NC; Department of Cardiovascular and Thoracic Surgery, WakeMed Heart and Vascular, Raleigh, NCWakeMed Health and Hospitals, Raleigh, NC; Department of Cardiovascular and Thoracic Surgery, WakeMed Heart and Vascular, Raleigh, NCObjectives: The majority of studies examining deep sternal wound infection (DSWI) prevention focus on ameliorating 1 variable at a time. There is a paucity of data regarding the synergistic effects of combining clinical and environmental interventions. This article describes an interdisciplinary, multimodal approach to eliminate DSWIs at a large community hospital. Methods: We developed a robust, multidisciplinary infection prevention team to evaluate and act in all phases of perioperative care to achieve a cardiac surgery DSWI rate of 0, named: the I hate infections team. The team identified opportunities for improved care and best practices and implemented changes on an ongoing basis. Results: Patient-related interventions consisted of preoperative methicillin-resistant Staphylococcus aureus identification, individualized perioperative antibiotics, antimicrobial dosing strategies, and maintenance of normothermia. Operative-related interventions involved glycemic control, sternal adhesives, medications and hemostasis, rigid sternal fixation for high-risk patients, chlorhexidine gluconate dressings over invasive lines, and use of disposable health care equipment. Environment-related interventions included optimizing operating room ventilation and terminal cleaning, reducing airborne particle counts, and decreasing foot traffic. Together, these interventions reduced the DSWI incidence from 1.6% preintervention to 0% for 12 consecutive months after full bundle implementation. Conclusions: A multidisciplinary team focused on eliminating DSWI identified known risk factors and implemented evidence-based interventions in each phase of care to ameliorate risk. Although the influence of each individual intervention on DSWI remains unknown, use of the bundled infection prevention approach reduced the incidence to 0 for the first 12 months after implementation.http://www.sciencedirect.com/science/article/pii/S2666250723001189sternal wound infectionsmediastinitispreventionenhanced recovery after surgerycardiac surgeryoperating room airborne contaminants |
| spellingShingle | Maren Downing, MEng Michael Modrow, PA-C Kelly A. Thompson-Brazill, DNP J. Erin Ledford, PharmD Charles D. Harr, MD, MBA Judson B. Williams, MD, MHS Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections teamCentral MessagePerspective JTCVS Techniques sternal wound infections mediastinitis prevention enhanced recovery after surgery cardiac surgery operating room airborne contaminants |
| title | Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections teamCentral MessagePerspective |
| title_full | Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections teamCentral MessagePerspective |
| title_fullStr | Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections teamCentral MessagePerspective |
| title_full_unstemmed | Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections teamCentral MessagePerspective |
| title_short | Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections teamCentral MessagePerspective |
| title_sort | eliminating sternal wound infections why every cardiac surgery program needs an i hate infections teamcentral messageperspective |
| topic | sternal wound infections mediastinitis prevention enhanced recovery after surgery cardiac surgery operating room airborne contaminants |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723001189 |
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