1585 Reducing Postoperative Surgical Site Infections in Coronary Artery Bypass Graft Patients

Shirley Zurcher, BSN, RN, CWOCN and Lee Ann Krapfl, BSN, RN, CWOCN, Mercy Medical Center, Wound/Ostomy Clinician, Dubuque, IA
Postoperative surgical site infection following coronary artery bypass graft (CABG) surgery is a costly and dangerous complication.  In 2008, a non-payment policy was implemented for complications deemed to be reasonably preventable, including mediastinitis.  Cardiovascular surgery poses an increased risk of infection because of comorbidities to include age, diabetes, obesity, and peripheral vascular disease.  The duration of surgery, ICU stay and mechanical ventilation are also thought to increase infection risk. CABG patients may acquire infection such as mediastinitis, thoracotomy, vein harvest sites or septicemia.  These infections increase the mortality rate and increase the hospital length of stay.  Mediastinitis can add an additional $50,000 to the cost of care.  OBJECTIVE: Routine surveillance of infection incidence showed an increased rate of postoperative surgical infections in CABG patients that were greater than the Iowa Average Benchmark.  A multidisciplinary quality improvement project was initiated with the goal of reducing postoperative surgical infections in CABG patients.  The study included 37 patients undergoing CABG surgery from January 2012 – July 2012. Lack of standardized incision care was identified for both sternal incisions and vein harvest sites.  Given the high-risk population and significant costs associated with CABG infections, a decision was made to institute silver impregnated silicone dressings along with a standard protocol for incision care.  OUTCOME: The practice changes achieved a 75% reduction in postoperative surgical infections in CABG patients from 10.94% to 2.7%, bringing the rate below the Iowa Average Benchmark.  The estimated cost avoidance would approach $250,000 per calendar year.  CONCLUSION: The standardization of incision care to include the use of silver impregnated dressings was part of an overall project to reduce postoperative surgical infections in CABG patients. The study was limited by sample size and time, though the analysis suggests a positive trend.  Continued performance with this trend may be statistically significant.