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Pediatric cardiac surgical site infections: A single-center quality improvement initiative
Nhat Chau1, Crystal Tran2, Megan Clarke3
1Faculty of Art and Science, University of Toronto, Toronto, Ontario, Canada.
Objective:
Pediatric cardiac surgery site infections (SSI) represent significant morbidity. Our institution reported elevated SSI rates of 3.48 per 100 cases over a 5-year period above target rates of 2.5 per 100 cases. Therefore, as a quality improvement initiative, we implemented interventions with the goal of decreasing SSI rates by 30%.
Methods:
Pediatric cardiovascular surgery patients (January 2021 to August 2023) who had SSI within 30 days of index operation were included (n = 1514) based on the National Healthcare Safety Network definition. Descriptive statistics were used to compare our preintervention cohort (pre-IV) (January 2021 to April 2022; n = 753) and postintervention cohort (post-IV) (May 2022 to August 2023; n = 761).
Results:
In the post-IV cohort, we found a significant decrease in total SSI (1.97 SSIs per 100 cases [15 out of 761]) versus pre-IV (3.85 SSIs per 100 cases [29 out of 753]), demonstrating a 48% reduction (P = .029). In our post-IV cohort, there was a significant reduction in superficial SSIs (pre-IV, 3.19 SSIs per 100 cases [24 out of 753] vs post-IV, 1.58 SSIs out of 100 cases [12 out of 761]; P = .04). Wounds presenting at 1 to 3 weeks were also reduced in our post-IV cohort (pre-IV, 2.66 SSIs per100 cases [20 out of 753] vs post-IV, 0.66 SSIs per 100 cases [5 out of 761]; P = .002). A significant reduction in SSIs in nonneonates was also noted (pre-IV, 2.79 SSIs per 100 cases [21 out of 753] vs post-IV, 0.92 SSIs per 100 cases [7 out of 761]; P = .007). Additionally, there was a significant reduction in SSIs associated with the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery 1 mortality category (P = .033) and the number of readmissions in the post-IV cohort (P = .042).
Conclusions:
A new surgical site dressing and multidisciplinary surveillance plan effectively reduced the overall burden of SSI rates at our institution. Future studies will address risk factors in specific subpopulations to further reduce SSIs at our institution.
Insights
Implementing a new surgical site dressing and surveillance plan significantly reduced pediatric cardiac surgery site infections (SSIs) by 48%. This quality improvement initiative successfully lowered SSI rates below target levels, enhancing patient safety.
Area of Science:
- Pediatric Cardiac Surgery
- Infection Control
- Quality Improvement
Background:
- Pediatric cardiac surgery site infections (SSIs) are a significant cause of morbidity.
- The institution experienced elevated SSI rates (3.48 per 100 cases) exceeding the target rate (2.5 per 100 cases).
Purpose of the Study:
- To implement interventions aimed at decreasing SSI rates by 30% as a quality improvement initiative.
- To evaluate the effectiveness of a new surgical site dressing and multidisciplinary surveillance plan.
Main Methods:
- A comparative study of pediatric cardiovascular surgery patients from January 2021 to August 2023.
- Inclusion criteria: SSI within 30 days of index operation, based on National Healthcare Safety Network definition (n=1514).
- Comparison of preintervention (n=753) and postintervention (n=761) cohorts using descriptive statistics.
Main Results:
- A 48% reduction in total SSIs was observed in the postintervention cohort (1.97 per 100 cases) compared to the preintervention cohort (3.85 per 100 cases) (P=.029).
- Significant decreases were noted in superficial SSIs, wounds presenting at 1-3 weeks, and SSIs in nonneonates.
- Reductions in SSIs associated with the STS-EACTS Congenital Heart Surgery 1 mortality category and readmissions were also significant.
Conclusions:
- A novel surgical site dressing and multidisciplinary surveillance plan effectively reduced the overall burden of SSI rates.
- The implemented interventions successfully decreased SSIs, demonstrating a significant improvement in patient outcomes.
- Future research will focus on identifying risk factors in specific subpopulations to further minimize SSIs.
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