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Hygienic interventions to decrease deep sternal wound infections following coronary artery bypass grafting.

B Lytsy1, R P F Lindblom2, U Ransjö1

  • 1Department of Medical Sciences, Unit for Clinical Microbiology and Infectious Medicine, Uppsala University, Uppsala, Sweden.

The Journal of Hospital Infection
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Summary

Root cause analysis and quality improvement interventions significantly reduced deep sternal wound infections (DSWIs) after coronary artery bypass grafting (CABG) surgery. This approach is effective for preventing healthcare-associated infections following cardiac procedures.

Keywords:
Coronary artery bypass graftDeep sternal wound infectionsHygiene policyMicrobiologyRoot cause analysis

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Area of Science:

  • Cardiothoracic Surgery
  • Infectious Disease Control
  • Quality Improvement Science

Background:

  • Uppsala University Hospital's Cardiothoracic Surgery department performs approximately 700 open-heart surgeries annually, including 250 isolated coronary artery bypass grafting (CABG) procedures.
  • In 2009, an unacceptable rise in deep sternal wound infections (DSWIs) was observed despite adherence to existing hygienic guidelines.

Purpose of the Study:

  • To investigate the impact of root cause analysis (RCA) combined with targeted quality improvement interventions on reducing DSWI rates in CABG patients.
  • To demonstrate the effectiveness of a systematic approach in mitigating healthcare-associated infections within a surgical setting.

Main Methods:

  • A prospective analysis of isolated CABG patients who developed DSWI and required surgical revision.
  • Infection etiology was investigated using standard microbiological analysis of wound swabs and tissue biopsies.
  • Root cause analysis (RCA) was conducted from September 2009 to April 2010, followed by the implementation of interventions based on findings and national recommendations.
  • Environmental air sampling was performed to assess microbial contamination levels near the sternal incision.

Main Results:

  • The incidence of DSWI after CABG surgery decreased from 5.1% pre-intervention to 0.9% post-intervention.
  • Pre-intervention wound cultures showed high rates of Staphylococcus aureus (27.1%) and coagulase-negative staphylococcus (CoNS) (47.1%).
  • Post-intervention, the rates of S. aureus decreased to 23.1% and CoNS to 30.8%, with air counts remaining below 5cfu/m³.

Conclusions:

  • Root cause analysis (RCA), involving both medical professionals and infection control teams, is a valuable tool for identifying multifactorial causes of adverse events like healthcare-associated infections.
  • Systematic quality improvement interventions, informed by RCA, can effectively reduce the incidence of deep sternal wound infections following coronary artery bypass grafting surgery.