Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients

Cathy Woodward, Richard Taylor, Minnette Son, Roozbeh Taeed, Marshall L Jacobs, Lauren Kane, Jeffrey P. Jacobs, S. Adil Husain

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI.

METHODS: Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries.

RESULTS: Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007.

CONCLUSION: A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

Original languageEnglish (US)
Pages (from-to)453-459
Number of pages7
JournalWorld journal for pediatric & congenital heart surgery
Volume8
Issue number4
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

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Wound Infection
Quality Improvement
Thoracic Surgery
Pediatrics
Guideline Adherence
Infection
Registries
Anti-Bacterial Agents
Sternum
Compliance
Software
Databases
Morbidity
Mortality

Keywords

  • pediatric
  • sternal wound infection
  • surgical site infection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients. / Woodward, Cathy; Taylor, Richard; Son, Minnette; Taeed, Roozbeh; Jacobs, Marshall L; Kane, Lauren; Jacobs, Jeffrey P.; Husain, S. Adil.

In: World journal for pediatric & congenital heart surgery, Vol. 8, No. 4, 01.07.2017, p. 453-459.

Research output: Contribution to journalArticle

Woodward, Cathy ; Taylor, Richard ; Son, Minnette ; Taeed, Roozbeh ; Jacobs, Marshall L ; Kane, Lauren ; Jacobs, Jeffrey P. ; Husain, S. Adil. / Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients. In: World journal for pediatric & congenital heart surgery. 2017 ; Vol. 8, No. 4. pp. 453-459.
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