A Quality Improvement Initiative to Reduce Surgical Site Infections in Patients Undergoing Delayed Sternal Closure
Prashant Jha1,2, Cathy S Woodward3,4, Heather Gardner3,4
1Division of Critical Care, Department of Pediatrics, Children's Hospital of Nevada, University Medical Center, 1800 W Charleston Blvd, Las Vegas, NV, 89128, USA. Prashant.Jha@umcsn.com.
Pediatric Cardiology
|June 20, 2020
Summary
A modified bundle approach for preventing sternal wound infections (SWI) in pediatric patients undergoing delayed sternal closure (DSC) after heart surgery shows promising results, with a reduction in SWI rates.
Area of Science:
- Pediatric Cardiac Surgery
- Infectious Disease Prevention
- Surgical Site Infections
Background:
- Sternal wound infections (SWI) pose a significant healthcare burden in pediatric patients requiring delayed sternal closure (DSC) after congenital heart surgery.
- Current guidelines for SWI prevention are not specific to pediatric DSC patients, highlighting a need for targeted interventions.
Purpose of the Study:
- To evaluate the effectiveness of a modified bundled approach in reducing the incidence of SWI in pediatric patients with DSC.
- To assess compliance with the modified protocol and its impact on infection rates.
Main Methods:
- A prospective cohort study was conducted comparing SWI rates before and after the implementation of a modified prevention protocol in pediatric DSC patients.
- Data on SWI, patient demographics, and protocol compliance were collected and analyzed.
Main Results:
- The SWI rate in DSC patients was 7.7% pre-intervention and 0% post-intervention (p=0.52).
- Compliance with the modified protocol bundle ranged from 93% to 100% during the post-intervention period.
- While not statistically significant due to small cohort size, the reduction in SWI is clinically significant due to associated economic burden and prolonged length of stay.
Conclusions:
- The modified bundled approach for SWI prevention in pediatric DSC patients appears promising in reducing infection rates.
- Further multicenter studies are warranted to confirm these preliminary findings and establish definitive guidelines.
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