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

Karolin Graf1, Dorit Sohr, Axel Haverich

  • 1Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, D-30625 Hannover, Germany. Graf.Karolin@MH-Hannover.DE

Interactive Cardiovascular and Thoracic Surgery
|May 7, 2009
PubMed

Insights

Implementing a bundle of infection control measures significantly reduced deep sternal surgical site infections (DSSI) in cardiac surgery patients. Key risk factors included advanced age and diabetes, while preoperative antibiotics and early extubation were protective.

Area of Science:

  • Infection Control
  • Surgical Outcomes
  • Public Health

Background:

  • Deep sternal surgical site infections (DSSI) pose a significant risk following cardiac surgery.
  • An increasing incidence of DSSI necessitated the implementation of enhanced infection control protocols.

Purpose of the Study:

  • To evaluate the effectiveness of a comprehensive, interdisciplinary infection control bundle in reducing DSSI rates.
  • To identify independent risk factors and protective factors associated with DSSI in cardiac surgery patients.

Main Methods:

  • A case-control study involving 120 patients each for cases and controls was conducted.
  • Multivariate analysis was used to identify significant risk and protective factors.
  • Key interventions included MRSA screening, decolonization, hair clipping, enhanced antibiotic stewardship, and wound care modifications.

Main Results:

  • The incidence of DSSI significantly decreased from 3.61% to 1.83% after implementing the infection control bundle.
  • Independent risk factors for DSSI were identified as age >68 years, diabetes mellitus, and intra-operative hyperglycemia (>8 mmol/l).
  • Preoperative antibiotic prophylaxis and extubation on the day of surgery were found to be protective factors.

Conclusions:

  • A multidisciplinary approach and strict adherence to infection control measures are crucial for reducing DSSI rates.
  • Awareness of patient-specific risk factors (age, diabetes, glucose control) and protective measures (antibiotics, early extubation) can optimize surgical outcomes.
  • Continuous surveillance of DSSI rates and risk factor analysis are recommended for cardiac surgical teams.

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