Reducing Deep Sternal Wound Infections following Cardiovascular Surgery

Purpose:To reduce the number of deep sternal wound infections following open heart surgery by half in FY 2014-2015

Background:Hospital acquired infections (HAI) after cardiothoracic surgery continue to challenge nurses working in the Cardio-Vascular Care Unit (CVCU). Over 20% of HAI cases following open heart surgery are traced to advanced age and obesity. Often the patient's own nasal, oral or skin flora is the primary source of infection. Four patients in the CVCU developed deep sternal wound infections during the fiscal year 2013-2014. The cost to treat one infection estimated 2.8 times the cost of that for a patient with uncomplicated postoperative course; a routine coronary/artery bypass graft and/or valve replacement range from $50,000-$200,000.

Methods:In this quality improvement project, physician orders sets were adjusted to include oral chlorhexidine gluconate rinses and intranasal antibiotic ointment; pre and post operatively. In addition, a new sternal wound care technique was implemented on high risk patients. If the patient had re-exploration, diabetes, body mass index >30, and/or age >65, then a short term negative pressure wound therapy (NPWT) system was placed over the closed sternal incision. This system promotes wound healing by promoting blood flow, removing exudate, forming granulation tissue under the incision, and maintain a sterile incision for up to seven days.

Results:Thus far, 382 patients have received open heart procedures with 29 of those having the NPWT applied during FY 2014-2015. Current post-operative infection rate is zero.

Conclusions:Optimizing perioperative order sets and applying a new sternal wound care technique on high risk patients, resulted in no sternal wound infections. Reduction of deep sternal wound infections exceeded our goal to reduce the number by half. The methods above are now part of our order sets for patients undergoing cardiac surgery.