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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.
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.
