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Published on: May 10, 2024
A Comprehensive Intervention Associated With Reduced Surgical Site Infections Among Pediatric Cardiovascular Surgery
Amanda L Adler1, Emily T Martin1, Gordon Cohen2
1Seattle Children's Hospital, and.
Insights
A new intervention significantly reduced surgical site infections (SSIs) in pediatric cardiovascular surgery patients, especially those with delayed wound closure. This improvement enhances patient safety and outcomes following complex procedures.
Area of Science:
- Infectious Disease
- Surgical Outcomes
- Public Health Interventions
Background:
- Surgical site infections (SSIs) are a major cause of morbidity and mortality in cardiovascular (CV) surgery.
- An increase in SSIs, particularly in patients with delayed wound closure, necessitated a targeted intervention.
Purpose of the Study:
- To implement and assess an intervention aimed at reducing SSIs in pediatric CV surgery patients.
- To evaluate the intervention's effectiveness at both population and patient levels.
Main Methods:
- Intervention focused on preoperative preparation, antibiotic protocols, and postoperative incision care, with special attention to delayed closures.
- Population-level analysis used interrupted time series; patient-level analysis involved retrospective chart review and multivariate risk assessment.
- National Healthcare Safety Network criteria were used for SSI identification.
Main Results:
- Population-level SSIs decreased by 6.7 per 100 surgeries post-intervention (P = .002).
- SSI rates in delayed closure patients dropped from 40% to 0.8% (P < .001); immediate closure rates decreased from 4.3% to 1.8% (P = .02).
- Preoperative antibiotic adherence significantly improved (60% to 92%; 5% to 79% for redosing).
Conclusions:
- The implemented intervention effectively reduced SSIs in pediatric CV surgery.
- The reduction was most pronounced in patients with delayed wound closures, highlighting the intervention's targeted success.
Background:
Surgical site infections (SSIs) cause significant morbidity and mortality in patients undergoing cardiovascular (CV) surgery. Following an increase in SSIs in this population, driven by a high rate in those with delayed closure, we implemented an intervention to reduce these infections and assessed the intervention using both population- and patient-level analyses.
Methods:
An intervention drawing from existing guidelines and targeting preoperative preparation of the patient, prophylactic antibiotics, and postoperative incision care was implemented. Special attention was paid to standardizing the care of the incision of patients with delayed closure. National Healthcare Safety Network criteria were used to prospectively identify SSIs. Population-level intervention effect was assessed using interrupted time series. To assess intervention adherence and effect in our patient population, retrospective chart review was performed on a cohort of patients undergoing cardiac procedures pre- and postintervention. Multivariate analysis was used to assess risk of SSI at the patient level.
Results:
Timely preoperative prophylactic antibiotic dosing increased from 60% preintervention to 92% postintervention, and redosing during prolonged surgeries increased from 5% to 79% (both, P < .001). At the population-level, a decrease of 6.7 infections per 100 surgeries per 6 months was observed directly following the intervention (P = .002). The SSI rate decreased from 40% to 0.8% (P < .001) in patients with delayed closure and from 4.3% to 1.8% (P = .02) in patients with immediate closure. In multivariate analyses, surgery prior to the intervention was the strongest predictor for SSI (incidence rate ratio, 3.98; 95% confidence interval, 1.59 to 9.97).
Conclusions:
Our intervention decreased SSIs in pediatric CV surgery patients, particularly those with delayed closures.
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