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Published on: January 5, 2015

Prevention of sternal wound infection in pediatric cardiac surgery: a protocolized approach

Cathy S Woodward1, Minnette Son, Richard Taylor

  • 1Division of Critical Care, Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX, USA.

World Journal for Pediatric & Congenital Heart Surgery
|June 28, 2013
PubMed

Insights

A new protocol reduced sternal wound infections (SWIs) in children after cardiac surgery. Focusing on patients with delayed sternal closure (DSC) may further improve infection rates.

Area of Science:

  • Pediatric cardiac surgery outcomes
  • Infection control in healthcare settings

Background:

  • Sternal wound infections (SWIs) are a significant complication in pediatric cardiac surgery, leading to increased morbidity, mortality, and costs.
  • Current guidelines for SWI prevention in children are lacking.

Purpose of the Study:

  • To implement and evaluate a quality improvement protocol aimed at reducing SWIs in pediatric cardiac surgery patients.
  • To assess the impact of the protocol on SWI incidence and identify risk factors.

Main Methods:

  • A multidisciplinary team developed and implemented a protocol to prevent SWIs.
  • A prospective review of 308 pediatric cardiac surgery patients over two years tracked protocol adherence and SWI incidence.
  • Centers for Disease Control definitions were used to diagnose surgical site infections.

Main Results:

  • A reduction in SWIs was observed between the first and second years of the study (OR = 0.35, P = .059).
  • Delayed sternal closure (DSC) was significantly associated with an increased risk of SWI (OR = 5.4, P ≤ .001).
  • Implementing the protocol for patients with DSC showed a trend towards decreased infections in the second year (14% to 4%, P = .14).

Conclusions:

  • The implemented protocol was associated with a decrease in SWIs in pediatric cardiac surgery patients.
  • Children with DSC represent a high-risk group for SWIs, necessitating targeted prevention strategies.
  • Further multicenter studies are recommended to validate a bundled protocol approach for SWI prevention.
Abstract

Keywords:
pediatricsternal wound infectionsternumsurgical site infection

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