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Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections team

OBJECTIVES: The majority of studies examining deep sternal wound infection (DSWI) prevention focus on ameliorating 1 variable at a time. There is a paucity of data regarding the synergistic effects of combining clinical and environmental interventions. This article describes an interdisciplinary, mu...

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Autores principales: Downing, Maren, Modrow, Michael, Thompson-Brazill, Kelly A., Ledford, J. Erin, Harr, Charles D., Williams, Judson B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10268509/
https://www.ncbi.nlm.nih.gov/pubmed/37324338
http://dx.doi.org/10.1016/j.xjtc.2023.03.019
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author Downing, Maren
Modrow, Michael
Thompson-Brazill, Kelly A.
Ledford, J. Erin
Harr, Charles D.
Williams, Judson B.
author_facet Downing, Maren
Modrow, Michael
Thompson-Brazill, Kelly A.
Ledford, J. Erin
Harr, Charles D.
Williams, Judson B.
author_sort Downing, Maren
collection PubMed
description OBJECTIVES: The majority of studies examining deep sternal wound infection (DSWI) prevention focus on ameliorating 1 variable at a time. There is a paucity of data regarding the synergistic effects of combining clinical and environmental interventions. This article describes an interdisciplinary, multimodal approach to eliminate DSWIs at a large community hospital. METHODS: We developed a robust, multidisciplinary infection prevention team to evaluate and act in all phases of perioperative care to achieve a cardiac surgery DSWI rate of 0, named: the I hate infections team. The team identified opportunities for improved care and best practices and implemented changes on an ongoing basis. RESULTS: Patient-related interventions consisted of preoperative methicillin-resistant Staphylococcus aureus identification, individualized perioperative antibiotics, antimicrobial dosing strategies, and maintenance of normothermia. Operative-related interventions involved glycemic control, sternal adhesives, medications and hemostasis, rigid sternal fixation for high-risk patients, chlorhexidine gluconate dressings over invasive lines, and use of disposable health care equipment. Environment-related interventions included optimizing operating room ventilation and terminal cleaning, reducing airborne particle counts, and decreasing foot traffic. Together, these interventions reduced the DSWI incidence from 1.6% preintervention to 0% for 12 consecutive months after full bundle implementation. CONCLUSIONS: A multidisciplinary team focused on eliminating DSWI identified known risk factors and implemented evidence-based interventions in each phase of care to ameliorate risk. Although the influence of each individual intervention on DSWI remains unknown, use of the bundled infection prevention approach reduced the incidence to 0 for the first 12 months after implementation.
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spelling pubmed-102685092023-06-15 Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections team Downing, Maren Modrow, Michael Thompson-Brazill, Kelly A. Ledford, J. Erin Harr, Charles D. Williams, Judson B. JTCVS Tech Adult: Perioperative Management OBJECTIVES: The majority of studies examining deep sternal wound infection (DSWI) prevention focus on ameliorating 1 variable at a time. There is a paucity of data regarding the synergistic effects of combining clinical and environmental interventions. This article describes an interdisciplinary, multimodal approach to eliminate DSWIs at a large community hospital. METHODS: We developed a robust, multidisciplinary infection prevention team to evaluate and act in all phases of perioperative care to achieve a cardiac surgery DSWI rate of 0, named: the I hate infections team. The team identified opportunities for improved care and best practices and implemented changes on an ongoing basis. RESULTS: Patient-related interventions consisted of preoperative methicillin-resistant Staphylococcus aureus identification, individualized perioperative antibiotics, antimicrobial dosing strategies, and maintenance of normothermia. Operative-related interventions involved glycemic control, sternal adhesives, medications and hemostasis, rigid sternal fixation for high-risk patients, chlorhexidine gluconate dressings over invasive lines, and use of disposable health care equipment. Environment-related interventions included optimizing operating room ventilation and terminal cleaning, reducing airborne particle counts, and decreasing foot traffic. Together, these interventions reduced the DSWI incidence from 1.6% preintervention to 0% for 12 consecutive months after full bundle implementation. CONCLUSIONS: A multidisciplinary team focused on eliminating DSWI identified known risk factors and implemented evidence-based interventions in each phase of care to ameliorate risk. Although the influence of each individual intervention on DSWI remains unknown, use of the bundled infection prevention approach reduced the incidence to 0 for the first 12 months after implementation. Elsevier 2023-04-14 /pmc/articles/PMC10268509/ /pubmed/37324338 http://dx.doi.org/10.1016/j.xjtc.2023.03.019 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Adult: Perioperative Management
Downing, Maren
Modrow, Michael
Thompson-Brazill, Kelly A.
Ledford, J. Erin
Harr, Charles D.
Williams, Judson B.
Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections team
title Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections team
title_full Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections team
title_fullStr Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections team
title_full_unstemmed Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections team
title_short Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections team
title_sort eliminating sternal wound infections: why every cardiac surgery program needs an i hate infections team
topic Adult: Perioperative Management
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10268509/
https://www.ncbi.nlm.nih.gov/pubmed/37324338
http://dx.doi.org/10.1016/j.xjtc.2023.03.019
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