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Clinical Trial
. 2017 May;18(5):461-468.
doi: 10.1097/PCC.0000000000001135.

Reducing Pediatric Sternal Wound Infections: A Quality Improvement Project

Claudia Delgado-Corcoran  1 , Charlotte S Van Dorn, Charles Pribble, Emily A Thorell, Andrew T Pavia, Camille Ward, Randall Smout, Susan L Bratton, Phillip T Burch
Affiliations
Clinical Trial

Reducing Pediatric Sternal Wound Infections: A Quality Improvement Project

Claudia Delgado-Corcoran et al. Pediatr Crit Care Med. 2017 May.

Abstract

Objectives: To evaluate whether a quality improvement intervention reduces sternal wound infection rates in children after cardiac surgery.

Design: This is a pre- and postintervention quality improvement study.

Setting: A 16-bed cardiac ICU in a university-affiliated pediatric tertiary care children's hospital.

Patients: All patients undergoing cardiac surgery via median sternotomy from January 2010 to December 2014 are included. The sternal wound infection rates for primary closure and delayed sternal closure are reported per 100 sternotomies. The hospital-acquired infection records were used to identify preintervention cases, while postintervention cases were collected prospectively.

Intervention: Implementation of a sternal wound prevention bundle during the preoperative, intraoperative, and postoperative periods for cardiac surgical cases.

Measurements and main results: During the preintervention period, 32 patients (3.8%) developed sternal wound infection, whereas only 19 (2.1%) developed sternal wound infection during the postintervention period (p = 0.04). The rates of sternal wound infection following primary closure were not significantly different pre- and postintervention (2.4% vs 1.6%; p = 0.35). However, patients with delayed sternal closure had significantly lower postintervention infection rates (10.6% vs 3.9%; p = 0.02).

Conclusions: Implementation of a sternal wound prevention bundle during the perioperative period was associated with lower sternal wound infection rates in surgeries with delayed sternal closure.

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Conflict of interest statement

Copyright form disclosure: Dr. Pavia’s institution received funding from BioFire DX (in kind support of NIH RO1 grant). He received funding from Alios (Data Safety and Monitoring Board) and from Antimicrobial Therapy Inc. (royalties as author). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1
Figure 1
Timeline of Interventions
Figure 2
Figure 2
Key Driver Diagram for reducing Sternal Wound Infections SWI= sternal wound infection; SWPB= sternal wound prevention bundle; PC= primary closure; DSC= delayed sternal closure; CICU= cardiac intensive care unit; CHG=chlorhexidine; CT= cardiothoracic
Figure 3
Figure 3
Statistical Process Control U Charts with Quarterly Sternal Wound Infections Rates Separated by Primary Closure and Delayed Sternal Closure SWI= sternal wound infection SWPB= sternal wound prevention bundle UCL= Upper Control Limit LCL= Lower Control Limit Ubar= Center Line
See this image and copyright information in PMC

References

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