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. 2025 Jun;22(6):e70710.
doi: 10.1111/iwj.70710.

Impact of Polyhexanide Care Bundle on Surgical Site Infections in Paediatric and Neonatal Cardiac Surgery: A Propensity Score-Matched Retrospective Cohort Study

Gianluca Castiello  1 , Giuseppe Caravella  2 , Greta Ghizzardi  3 , Gianluca Conte  4 , Arianna Magon  4 , Tiziana Fiorini  5 , Laurenzia Ferraris  6 , Simona De Vecchi  7 , Veronica Calorenne  1 , Andreea Alina Andronache  8 , Alessandro Varrica  9 , Alessandro Giamberti  9 , Antonio Saracino  8 , Rosario Caruso  10   11
Affiliations

Impact of Polyhexanide Care Bundle on Surgical Site Infections in Paediatric and Neonatal Cardiac Surgery: A Propensity Score-Matched Retrospective Cohort Study

Gianluca Castiello et al. Int Wound J. 2025 Jun.

Abstract

The primary aim of this study was to evaluate the impact of the polyhexamethylene biguanide (PHMB) care bundle on the occurrence rates of surgical site infections (SSIs) in paediatric and neonatal cardiac surgery, addressing a critical gap in paediatric-specific infection prevention protocols. A retrospective cohort study included patients under 18 years old who underwent cardiac surgery at IRCCS Policlinico San Donato. Cohort A (n = 117) received the PHMB care bundle from April to December 2023, while Cohort B (n = 801) received conventional care from September 2020 to March 2023. The 1:1 propensity score matching was used to balance covariates between cohorts, resulting in two comparable cohorts (Cohort A = 114 patients and Cohort B = 112). The study found a significant reduction in SSIs among patients receiving the PHMB care bundle compared with those receiving conventional care (1.8% vs. 7.1%, p = 0.048). The comprehensive nature of the PHMB care bundle, including educational programs, preoperative and postoperative antimicrobial treatments, and consistent application of best practices, was instrumental in achieving these outcomes. Implementing antimicrobial care bundles could significantly reduce SSIs in paediatric cardiac surgery. Future research is needed to refine the tested bundle with prospective approaches.

Keywords: cardiac surgery; infection control; paediatric surgery; polyhexanide; surgical site infection.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article. Authors G.C. and G.G. are married to each other, but this personal relationship has not influenced the conduct or reporting of the work described in this article.

Figures

FIGURE 1
FIGURE 1
Flow chart of record selection. This diagram illustrates the selection of 921 records assessed for eligibility, including 117 patients exposed to the PHMB‐based care bundle (Cohort A) and 801 patients receiving conventional care (Cohort B). After excluding 3 records due to non‐adherence to the PHMB‐based protocol, 918 records were retained for matching. Following 1:1 propensity score matching, 114 records in Cohort A and 112 in Cohort B were included in the final analysis.
FIGURE 2
FIGURE 2
Covariate balance and propensity score distribution. The top panel displays standardised mean differences for each covariate before (red) and after (blue) propensity score matching, demonstrating improved balance post‐matching. The bottom panel shows the distribution of propensity scores in treated and control groups before and after matching, indicating effective alignment of covariate distribution between the two groups.
See this image and copyright information in PMC

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