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Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients
Cathy Woodward1, Richard Taylor1, Minnette Son1
11 Department of Pediatrics, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA.
Insights
A multicenter quality improvement project successfully reduced sternal wound infections (SWIs) in pediatric cardiac surgery patients. Adherence to a protocol and timely antibiotic administration were key factors in decreasing infection rates.
Area of Science:
- Pediatric Cardiac Surgery
- Infectious Disease Prevention
- Quality Improvement Science
Background:
- Pediatric cardiac surgery patients face significant risks of sternal wound infections (SWIs), impacting morbidity and mortality.
- Previous single-center studies indicated that bundled quality improvement (QI) initiatives can effectively lower SWI rates.
Purpose of the Study:
- To evaluate the effectiveness of a standardized, protocolized approach in reducing SWIs across multiple pediatric cardiac surgery centers.
- To assess the impact of a collaborative QI effort on infection rates and patient outcomes.
Main Methods:
- Nine pediatric cardiac surgery programs collaborated on a multicenter QI project.
- Implemented a standardized protocol for SWI prevention and collected compliance data.
- Utilized local clinical registries and Society of Thoracic Surgeons Congenital Heart Surgery Database-compliant software for data collection on 4,198 children.
Main Results:
- The average time between SWIs increased significantly, from 68.2 days to 130 days.
- Overall SWI rates decreased post-implementation (1.9% pre-protocol vs. 1.5% post-protocol, though not statistically significant, P = .18).
- Timely administration of pre-operative antibiotics was associated with significantly lower SWI rates (1.9% vs. 4.1%, P = .007).
Conclusions:
- A multicenter QI initiative effectively extended the interval between SWIs and showed a trend toward reduced infection rates.
- Protocol compliance improved significantly over the study period.
- Appropriate timing of pre-operative antibiotics is a critical factor in reducing SWIs in pediatric cardiac surgery patients.
Background:
Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI.
Methods:
Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries.
Results:
Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007.
Conclusion:
A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.
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