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A Postoperative Care Bundle Reduces Surgical Site Infections in Pediatric Patients Undergoing Cardiac Surgeries

Thomas J Caruso, Ellen Y Wang, Hayden Schwenk

    Joint Commission Journal on Quality and Patient Safety
    |September 2, 2018
    PubMed

    Insights

    A new care bundle significantly reduced surgical site infections (SSIs) in pediatric cardiac surgery patients. This intervention lowered SSI rates from 3.4 to 0.9 per 100 procedures, demonstrating effective infection control during prolonged cardiovascular intensive care unit recovery.

    Area of Science:

    • Pediatric cardiac surgery
    • Infection control
    • Healthcare quality improvement

    Background:

    • Pediatric cardiac surgery patients face high surgical site infection (SSI) risk due to prolonged procedures and recovery.
    • Existing guidelines inadequately address SSIs during extended cardiovascular intensive care unit (CVICU) stays.
    • A significant portion of cardiac patients developed SSIs during prolonged CVICU recoveries.

    Purpose of the Study:

    • To implement and evaluate a postoperative SSI reduction care bundle for pediatric cardiac surgery patients.
    • To decrease cardiac SSIs by 50%, aiming for a reduction from 3.4 to 1.7 SSIs per 100 procedures.
    • To identify key drivers and care elements for reducing SSIs during prolonged CVICU recovery.

    Main Methods:

    • A multidisciplinary team developed 11 postoperative SSI reduction care elements based on five key drivers.
    • The study was conducted at a quaternary pediatric academic center, utilizing historical control data (Jan 2013-May 2015) and intervention data (Jun 2015-Mar 2017).
    • Statistical process control charts and Pearson's chi-square test were used to measure compliance and SSI rates.

    Main Results:

    • Pre-intervention: 3.4 SSIs per 100 pediatric cardiac surgeries (27 SSIs in 799 procedures).
    • Post-intervention: SSI rate significantly decreased to 0.9 per 100 procedures (5 SSIs in 570 procedures).
    • The reduction in SSI rates was statistically significant (p=0.0045).

    Conclusions:

    • The implemented care bundle effectively reduced SSIs in pediatric cardiac surgery patients.
    • The study demonstrated the sustainability of the SSI reduction strategies.
    • The findings provide a framework for reducing SSIs during prolonged CVICU recoveries.
    Abstract

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