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Reducing Pediatric Sternal Wound Infections: A Quality Improvement Project
Claudia Delgado-Corcoran1, Charlotte S Van Dorn, Charles Pribble
11Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT. 2Divisions of Pediatric Critical Care Medicine and Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN. 3Division of Infectious Disease, Department of Pediatrics, University of Utah, Salt Lake City, UT. 4Pediatric Intensive Care Department, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT. 5Information Technology Department, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT. 6Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT.
Insights
A quality improvement intervention significantly reduced sternal wound infections in children after cardiac surgery, particularly in cases with delayed sternal closure. This initiative improved patient outcomes in pediatric cardiac surgery.
Area of Science:
- Pediatric cardiac surgery
- Quality improvement initiatives
- Infection control in healthcare settings
Background:
- Sternal wound infections are a significant complication following pediatric cardiac surgery.
- Reducing infection rates is crucial for improving patient outcomes and reducing healthcare costs.
Purpose of the Study:
- To evaluate the effectiveness of a quality improvement intervention in reducing sternal wound infection rates in children undergoing cardiac surgery.
- To assess the impact of the intervention on both primary and delayed sternal closure procedures.
Main Methods:
- A pre- and postintervention quality improvement study was conducted in a pediatric cardiac ICU.
- Data included all patients undergoing cardiac surgery via median sternotomy from January 2010 to December 2014.
- A sternal wound prevention bundle was implemented across preoperative, intraoperative, and postoperative periods.
Main Results:
- Overall sternal wound infection rates decreased from 3.8% preintervention to 2.1% postintervention (p = 0.04).
- Infection rates for primary sternal closure did not significantly change (2.4% vs 1.6%; p = 0.35).
- Infection rates for delayed sternal closure significantly decreased from 10.6% to 3.9% (p = 0.02).
Conclusions:
- A perioperative sternal wound prevention bundle effectively reduced sternal wound infection rates in pediatric cardiac surgery.
- The intervention demonstrated a significant benefit for patients undergoing delayed sternal closure.
- Quality improvement strategies are vital for enhancing safety in pediatric cardiac surgical procedures.
Objectives:
To evaluate whether a quality improvement intervention reduces sternal wound infection rates in children after cardiac surgery.
Design:
This is a pre- and postintervention quality improvement study.
Setting:
A 16-bed cardiac ICU in a university-affiliated pediatric tertiary care children's hospital.
Patients:
All patients undergoing cardiac surgery via median sternotomy from January 2010 to December 2014 are included. The sternal wound infection rates for primary closure and delayed sternal closure are reported per 100 sternotomies. The hospital-acquired infection records were used to identify preintervention cases, while postintervention cases were collected prospectively.
Intervention:
Implementation of a sternal wound prevention bundle during the preoperative, intraoperative, and postoperative periods for cardiac surgical cases.
Measurements And Main Results:
During the preintervention period, 32 patients (3.8%) developed sternal wound infection, whereas only 19 (2.1%) developed sternal wound infection during the postintervention period (p = 0.04). The rates of sternal wound infection following primary closure were not significantly different pre- and postintervention (2.4% vs 1.6%; p = 0.35). However, patients with delayed sternal closure had significantly lower postintervention infection rates (10.6% vs 3.9%; p = 0.02).
Conclusions:
Implementation of a sternal wound prevention bundle during the perioperative period was associated with lower sternal wound infection rates in surgeries with delayed sternal closure.
