Surgical site infections in cardiac surgery: an 11-year perspective

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.

Infection documentation used Centers for Disease Control and Prevention (CDC) criteria and a postdischarge questionnaire. Infections were stratified by risk class. Strategies used to lower SSI rates included active surveillance and provision of authenticated SSI rate plus surgeon-specific rates. Interventions included outbreak analyses and targeted nasal mupirocin plus chlorhexidine showering.

The rate of coronary artery bypass-related SSIs declined from >8% to <2%, comparing extremely favorably with CDC national data. Percentage of infections documented by postdischarge questionnaire was variable and did not change during the study period. Most SSIs were at the harvest site. Routine implementation of nasal mupirocin plus chlorhexidine preoperative showering effectively disrupted an outbreak of Staphylococcus aureus, and statistically decreased rates of postoperative infections with this organism.

Regular provision of authenticated and verified data, use of postdischarge questionnaires, and careful attention to adverse trends and outbreaks with appropriate actions can substantially decrease rates of infections in coronary artery bypass operation.