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A Quality Improvement Initiative to Reduce Surgical Site Infections in Patients Undergoing Delayed Sternal Closure After Pediatric Cardiac Surgery

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Abstract

Sternal wound infections (SWI) in delayed sternal closure (DSC) patients are a healthcare burden after congenital heart surgery. There are no guidelines specific for pediatric DSC patients to prevent this costly complication. The hypothesis was that the modifications to a bundled approach for DSC patients would decrease the SWI rate. For this prospective cohort study, DSC patients were postoperatively admitted to a pediatric cardiac care unit from February 2017 to January 2018. Using a modified protocol for prevention of SWI, the infection rates pre- and post-modified protocol were compared. The primary outcome measure was SWI. Secondary outcome measures were compliance with modifications. Retrospective review of cases in pre-protocol modification era from January 1, 2014 to December 31, 2016 showed 377 pediatric cardiopulmonary bypass cases and 39 (10.4%) underwent DSC. During the post-protocol modification era, there were 129 cardiopulmonary bypass cases and 17 (13%) DSC cases. The SWI rate in DSC were 7.7% and 0% for pre-intervention and post-intervention, respectively (p = 0.52). The Bayesian confidence interval with Jeffreys prior gives a 95% confidence interval of 1.5% to 18.3% for pre-intervention and 0 to 13.5% for post-intervention. Compliance with the protocol bundle during the post protocol era was 93–100%. Although preliminary results are not statistically significant due to cohort size, the economic burden and increased LOS for each SWI is clinically significant. The early results of reduced infections for DSC patients using a modified bundle approach appear promising. Continued study and a multicenter project would be beneficial.

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Abbreviations

DSC:

Delayed sternal closure

SWI:

Sternal wound infection

STS:

Society of thoracic surgery

SCIP:

Surgical Care Improvement Project

SSI:

Surgical site infection

PCCU:

Pediatric cardiac care unit

CHG:

Chlorhexidine Gluconate

SWIP:

Sternal wound infection prevention

OR:

Operating room

RACHS:

Risk Adjustment for Congenital Heart Surgery scoring

EHR:

Electronic health record

WOW:

Workstation on wheel

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Acknowledgements

We would like to thank you Judith Livingston, PhD, Independent Consultant, Education and Professional Development Formerly Assistant Professor, Department of Pediatrics, University of Texas Health Science Center at San Antonio for her help with reviewing and proofreading the manuscript.

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Authors and Affiliations

  1. Division of Critical Care, Department of Pediatrics, Children’s Hospital of Nevada, University Medical Center, 1800 W Charleston Blvd, Las Vegas, NV, 89128, USA

    Prashant Jha

  2. Department of Pediatrics, University of Nevada at Las Vegas, Las Vegas, NV, USA

    Prashant Jha

  3. Pediatric Services, University Hospital – University Health System, 4502 Medical Dr, San Antonio, TX, 78229, USA

    Cathy S. Woodward, Heather Gardner & Clinton Pietz

  4. Division of Pediatric Critical Care, Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Cathy S. Woodward, Heather Gardner & Clinton Pietz

  5. Division of Pediatric Cardiothoracic Surgery, The University of Utah’s School of Medicine, Salt Lake City, UT, USA

    S. Adil Husain

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  1. Prashant Jha
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  2. Cathy S. Woodward
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  3. Heather Gardner
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  4. Clinton Pietz
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  5. S. Adil Husain
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Correspondence to Prashant Jha.

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Jha, P., Woodward, C.S., Gardner, H. et al. A Quality Improvement Initiative to Reduce Surgical Site Infections in Patients Undergoing Delayed Sternal Closure After Pediatric Cardiac Surgery. Pediatr Cardiol 41, 1402–1407 (2020). https://doi.org/10.1007/s00246-020-02396-x

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  • DOI: https://doi.org/10.1007/s00246-020-02396-x

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