Outcomes following the implementation of a quality control campaign to decrease sternal wound infections after
Rickard P F Lindblom1, Birgitta Lytsy2, Camilla Sandström3
1Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, 751 85, Uppsala, Sweden. rickard.lindblom@ki.se.
Insights
Implementing an intervention program significantly reduced sternal wound infections (SWI) after coronary artery by-pass grafting (CABG). This improvement was observed despite no change in patient health, highlighting the intervention
Area of Science:
- Cardiothoracic Surgery
- Infectious Disease Prevention
- Patient Safety
Background:
- Coronary artery by-pass grafting (CABG) is optimal for complex coronary artery disease but carries risks of sternal wound infections (SWI).
- Uppsala University Hospital observed a rise in SWI, peaking in 2009, necessitating a review of surgical processes.
- Post-operative infection monitoring involved patient questionnaires regarding wound infection treatments.
Purpose of the Study:
- To evaluate the effectiveness of an intervention program aimed at reducing sternal wound infections (SWI) following coronary artery by-pass grafting (CABG).
- To determine if changes in patient population characteristics influenced SWI rates post-intervention.
Main Methods:
- A retrospective study included patients undergoing isolated CABG between 2006 and 2012.
- Data from 1515 patients (92.3% response rate) were analyzed, comparing the pre-intervention (2006-early 2010) and post-intervention (early 2010-2012) periods.
- Medical records were reviewed to assess risk factors and rule out changes in patient demographics as the cause for SWI frequency changes.
Main Results:
- A significant decrease in the frequency of sternal wound infections (SWI) was observed following the implementation of the intervention program.
- The reduction in SWI was not attributable to improvements in the overall health status of the patient population.
Conclusions:
- The implemented intervention program positively impacted patient outcomes by reducing the incidence of SWI after CABG.
- Due to simultaneous changes in perioperative care, the specific component most effective in reducing SWI could not be isolated.
Background:
Coronary artery by-pass grafting (CABG) remains the optimal strategy in achieving complete revascularization in patients with complex coronary artery disease. However, sternal wound infections (SWI), especially deep SWI are potentially severe complications to the surgery. At the department of cardiothoracic surgery in Uppsala University Hospital a gradual increase in all types of SWI occurred, which peaked in 2009. This prompted an in-depth revision of the whole surgical process. To monitor the frequency of post-operative infections all patients receive a questionnaire that enquires whether any treatment for wound infection has been carried out.
Methods:
All patients operated with isolated CABG between start of 2006 and end of 2012 were included in the study. 1515 of 1642 patients answered and returned the questionnaire (92.3 %). The study period is divided into the time before the intervention program was implemented (2006-early 2010) and the time after the intervention (early 2010- end 2012). To assess whether potential differences in frequency of SWI were a consequence of change in the characteristics of the patient population rather than an effect of the intervention a retrospective assessment of medical records was performed, where multiple of the most known risk factors for developing SWI were studied.
Results:
We noticed a clear decrease in the frequency of SWI after the intervention. This was not a consequence of a healthier population.
Conclusions:
Our results from implementing the intervention program are positive in that they reduce the number of SWI. As several changes in the perioperative care were introduced simultaneously we cannot deduce which is the most effective.
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