Implementation of bundled interventions greatly decreases deep sternal wound infection following cardiovascular surgery

Abstract

Complete implementation of simple multidisciplinary prevention measures as a bundle can greatly decrease the incidence of DSWI.

Deep sternal wound infection after cardiac surgery in the Chinese population: a single-centre 15-year retrospective study

“…It was a little different from other studies that have been published (17)(18)(19)(20)(21), which have reported that operation time but not CPB time was a risk factor for DSWI. Prolonged CPB time may be associated with complex procedures and more surgical implants; patients who undergo reoperation often suffer a worse tissue situation and need more time, usually because of bleeding or unstable haemodynamics.…”

Postoperative sternal wound infection

“…4 prophylaxis; however, inappropriate use of prophylactic mupirocin and vancomycin can lead to resistant bacterial strains. 1 Poor compliance is a problem with this preventive measure. 2 • Preoperative chlorhexidine skin cleansing and application of povidone-iodine antiseptic paint is a typical component of care bundles.…”

“…The STS currently recommends blood glucose levels less than 180 mg/dL. 1 Sternal wound healing is impaired if the sternal edges aren't properly aligned. 13 • Appropriate perioperative antibiotic prophylaxis improves surgical outcomes.…”

“…13 • The use of clippers for skin prep instead of razors reduces the rate of SWI. 1 • Surgical glove pinholes are rare; however, double gloving reduces the number of glove perforations. Antibiotic choice includes Gram-positive coverage since these organisms account for the majority of SWI; cefazolin is the current cephalosporin of choice.…”

Arterial grafting and the risk of sternal infection: How we can learn from our experience

“…In fact, others have reported the success of this ''bundled'' approach to reducing DSWI after cardiac surgery. 23 What is more instructive than the actual measures used is the process by which the authors addressed the topic. Not satisfied with improvement, they persisted in their efforts until they had, at least for now, eliminated the problem.…”