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Toward further reducing wound infections in cardiac operations
I W Brown1, G F Moor, B W Hummel
1Department of Cardiovascular Surgery, Watson Clinic, Lakeland, Florida 33804-5000, USA.
Background:
Serious wound infections such as mediastinitis still occur at a rate of 0.8% to 2.0%, according to the most recently published cardiac operative series.
Methods:
Data from careful surveillance for infection have been collected prospectively during a 4.5-year period on 1,717 patients who underwent cardiac operations performed under direct ultraviolet C radiation.
Results:
The rate for mediastinitis was 0.23%, and for deep incisional infection without mediastinitis, 0.12%; these rates are significantly lower than those for eight of nine of the most recently published cardiac series. When our infection rates were stratified using the National Nosocomial Infection Surveillance risk index, they were also significantly lower in the most important risk categories than the corresponding stratified rates collected from the participating hospitals of the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance system.
Conclusions:
Though we lack the proof that only a large, randomized study might provide, certainly, one possible explanation for our lower wound infection rate was the use of bactericidal ultraviolet C radiation during operation. This is a simple and effective means of minimizing operating room airborne bacteria as one possible source of these infections.
Insights
Ultraviolet C (UVC) radiation during cardiac surgery significantly reduced serious wound infections like mediastinitis. This simple method lowers infection rates compared to standard practices, enhancing patient safety in cardiac operations.
Area of Science:
- Medical Microbiology
- Surgical Infection Prevention
- Public Health
Background:
- Serious wound infections, including mediastinitis, remain a concern in cardiac surgery, with reported rates between 0.8% and 2.0%.
- Existing surveillance data highlights the persistent challenge of controlling infection rates in operative settings.
Purpose of the Study:
- To evaluate the efficacy of ultraviolet C (UVC) radiation in reducing surgical site infections during cardiac operations.
- To compare infection rates in patients undergoing cardiac surgery with UVC exposure versus historical controls.
Main Methods:
- Prospective surveillance of infection data was conducted over 4.5 years for 1,717 patients.
- Cardiac operations were performed under direct ultraviolet C (UVC) radiation to minimize airborne bacteria.
- Infection rates were stratified using the National Nosocomial Infection Surveillance (NNIS) risk index for comparison.
Main Results:
- The mediastinitis rate was 0.23%, and deep incisional infection without mediastinitis was 0.12%.
- These rates are significantly lower than those reported in recent cardiac surgery series.
- Stratified analysis using the NNIS risk index also showed significantly lower infection rates compared to CDC NNIS data.
Conclusions:
- The use of bactericidal ultraviolet C (UVC) radiation during cardiac operations is a potential explanation for the observed lower wound infection rates.
- UVC radiation offers a simple and effective method for minimizing airborne bacteria in the operating room, a key source of surgical site infections.
- While not definitive proof, the findings suggest UVC radiation as a valuable adjunct for infection control in cardiac surgery.