Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-28T17:21:45.473Z Has data issue: false hasContentIssue false
  • English
  • Français

Results of a Comprehensive Infection Control Program for Reducing Surgical-Site Infections in Coronary Artery Bypass Surgery

Published online by Cambridge University Press:  02 January 2015

Samuel J. McConkey ,
Paul B. L'Ecuyer ,
Denise M. Murphy ,
Terry L. Leet ,
Thoralf M. Sundt  and
Victoria J. Fraser
Samuel J. McConkey
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Paul B. L'Ecuyer
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Denise M. Murphy
Affiliation:
Department of Infection Control, Barnes Hospital, St Louis, Missouri
Terry L. Leet
Affiliation:
Center for Healthcare Quality and Effectiveness, BJC Health System, St Louis, Missouri
Thoralf M. Sundt
Affiliation:
Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, 660 South Ave, Box 8051, St Louis, MO 63110
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the efficacy of a comprehensive infection control program on the reduction of surgical-site infections (SSIs) following coronary artery bypass graft (CABG) surgery.

Design:

Prospective cohort study.

Setting:

1,000-bed tertiary-care hospital.

Patients:

Persons undergoing CABG with or without concomitant valve surgery from April 1991 through December 1994.

Interventions:

Prospective surveillance, quarterly reporting of SSI rates, chlorhexidene showers, discontinuation of shaving, administration of antibiotic prophylaxis in the holding area, elimination of ice baths for cooling of cardioplegia solution, limitation of operating room traffic, minimization of flash sterilization, and elimination of postoperative tap-water wound bathing for 96 hours. Logistic regression models were fitted to assess infection rates over time, adjusting for severity of illness, surgeon, patient characteristics, and type of surgery.

Results:

2,231 procedures were performed. A reduction in infection rates was noted at all sites. The rate of deep chest infections decreased from 2.6% in 1991 to 1.6% in 1994. Over the same period, the rate of leg infections decreased from 6.8% to 2.7%, and of all SSI from 12.4% to 8.9%. The adjusted odds ratio (OR) for all SSIs for the end of 1994 compared to December 31,1991, was 0.37 (95% confidence interval [CI95], 0.22-0.63). For deep chest and mediastinal infections, the adjusted OR comparing the same period was 0.69 (CI95, 0.28-1.71).

Conclusions:

We observed significant reductions in SSI rates of deep and superficial sites in CABG surgery following implementation of a comprehensive infection control program. These differences remained significant when adjusted for potential confounding covariables

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 8 , August 1999 , pp. 533 - 538
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Taylor, GJ, Mikell, FL, Moses, HW, Dove, JT, Katholi, RE, Malik, SA, et al. Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complications. Am J Cardiol 1990;65:309–313.CrossRefGoogle ScholarPubMed
2.Sellick, JA Jr, Stelmach, M, Mylotte, JM. Surveillance of surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol 1991;12:591–596.CrossRefGoogle ScholarPubMed
3.Culliford, A, Cunningham, J, Zeff, R, Isom, O, Teiko, P, Spencer, F. Sternal and costochondral infections following open-heart surgery: a review of 2,594 cases. J Thorac Cardiovasc Surg 1976;72:714–726.CrossRefGoogle Scholar
4.Bor, DH, Rose, RM, Modlin, JF, Weintraub, R, Friedland, GH. Mediastinals after cardiovascular surgery. Rev Infect Dis 1983;5:885–897.CrossRefGoogle Scholar
5.Breyer, RH, Mills, SA, Hudspeth, AS, Johnston, FR, Cordell, AR. A prospective study of sternal wound complications. Ann Thorac Surg 1984;37:412–416.CrossRefGoogle ScholarPubMed
6.Sarr, M, Gott, V, Townsend, T. Mediastinal infection after cardiac surgery. Ann Thorac Surg 1984;38:415–423.CrossRefGoogle ScholarPubMed
7.Grossi, EA, Culliford, AT, Krieger, KH, Kloth, D, Press, R, Baumann, FG, et al. A survey of 77 major infectious complications of median sternotomy: a review of 7,949 consecutive operative procedures. Ann Thorac Surg 1985;40:214–223.CrossRefGoogle Scholar
8.Cheung, EH, Craver, JM, Jones, EL, Murphy, DA, Hatcher, CR Jr, Guyton, RA. Mediastinitis after cardiac valve operations: impact upon survival. J Thorac Cardiovasc Surg 1985;90:517–522.CrossRefGoogle ScholarPubMed
9.Newman, LS, Szczukowski, LC, Bain, RP, Perlino, CA. Suppurative mediastinitis after open heart surgery: a case control study of risk factors. Chest 1988;94:546–553.CrossRefGoogle ScholarPubMed
10.Cosgrove, DM, Lytle, BW, Loop, FD, Taylor, PC, Stewart, RW, Cutl, CC, et al. Does bilateral internal mammary artery grafting increase surgical risk? J Thorac Cardiovasc Surg 1988;95:850–856.CrossRefGoogle ScholarPubMed
11.Kouchoukos, NT, Wareing, TH, Murphy, SF, Pelate, C, Marshal, WG Jr. Risks of bilateral internal mammary artery bypass grafting. Ann Thorac Surg 1990;49:210–219.CrossRefGoogle ScholarPubMed
12.Demmy, TL, Park, SB, Liebler, GA, Burkholder, JA, Maher, TD, Benchart, DH, et al. Recent experience with major sternal wound complications. Ann Thorac Surg 1990;49:458–462.CrossRefGoogle ScholarPubMed
13.Loop, F, Lytle, B, Cosgrove, D, Mahtood, S, McHenry, MC, Gootmastic, M, et al. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg 1990;49:179–187.CrossRefGoogle ScholarPubMed
14.Grossi, EA, Esposito, R, Harris, LJ, Crooke, GA, Galloway, AL, Colvin, SB, et al. Sternal wound infections and use of internal mammary artery grafts. J Thorac Cardiovasc Surg 1991;102:342–347.CrossRefGoogle ScholarPubMed
15.Nishida, H, Grooters, RK, Soltanzadeh, H, Thieman, KC, Schneider, RF, Kim, WP. Discriminate use of electrocautery on the median sternotomy incision: a 0.16% wound infection rate. J Thorac Cardiovasc Surg 1991;101:488–494.CrossRefGoogle ScholarPubMed
16.Gaynes, R, Marosok, R, Mowry-Hanley, J, Laughlin, C, Foleg, K, Friedman, C, et al. Mediastinitis following coronary artery bypass surgery: a 3-year review. J Infect Dis 1991;163:117–121.CrossRefGoogle ScholarPubMed
17.Ehrenkranz, NJ, Pfaff, SJ. Mediastinitis complicating cardiac operations: evidence of postoperative causation. Rev Infect Dis 1991;13:803–814.CrossRefGoogle ScholarPubMed
18.Ko, W, Lazenby, WD, Zelano, JA, Isom, W, Krieger, KH. Effects of shaving methods and intraoperative irrigation on suppurative mediastinitis after bypass operations. Ann Thorac Surg 1992;53:301–305.CrossRefGoogle ScholarPubMed
19.He, GW, Ryan, WH, Acuff, TE, Bowman, RT, Douthit, MB, Yang, CQ, et al. Risk factors for operative mortality and sternal wound infection in bilateral internal mammary artery grafting. J Thorac Cardiovasc Surg 1994;107:196–202.CrossRefGoogle ScholarPubMed
20.Nelson, R, Dries, D. Economic implications of infection in cardiac surgery. Ann Thorac Surg 1986;42:240–246.CrossRefGoogle ScholarPubMed
21.L'Ecuyer, PB, Murphy, D, Little, JR, Fraser, VJ. The epidemiology of chest and leg wound infections following cardiothoracic surgery. Clin Infect Dis 1996;22:424–429.CrossRefGoogle ScholarPubMed
22.Bjerke, NB, Bifano, S. Epidemiology of surgical site infections following coronary artery bypass graft surgery. In: Program of the 6th Annual Meeting of the Society for Healthcare Epidemiology of America; 1996; Washington, DC. Abstract 24.Google Scholar
23.Boyce, JM, Potter-Bynoe, G, Dziobek, L. Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol 1990;11:89–93.CrossRefGoogle ScholarPubMed
24.Cruse, PJE, Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:27–40.CrossRefGoogle Scholar
25.Condon, RE, Schulte, WJ, Malangoni, MA, Anderson-Teschendorf, MJ. Effectiveness of a surgical wound surveillance program. Arch Surg 1983;118:303–307.CrossRefGoogle ScholarPubMed
26.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG, Mann, VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.CrossRefGoogle ScholarPubMed
27.Olson, MM, Lee, JT. Continuous, 10-year wound infection surveillance. Arch Surg 1990;125:794–803.CrossRefGoogle ScholarPubMed
28.Culver, DH, Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91 (suppl 3B):152S–157S.CrossRefGoogle ScholarPubMed
29.Haley, RW. Nosocomial infections in surgical patients: developing valid measures of intrinsic patient risk. Am J Med 1991;91 (suppl 3B):145S–151S.CrossRefGoogle ScholarPubMed
30.Ferrazzi, P, Allen, R, Crupi, G, Reyes, I, Parenzan, L, Maisonnet, M. Reduction of infection after cardiac surgery: a clinical trial. Ann Thorac Surg 1986;42:321–325.CrossRefGoogle ScholarPubMed
31.Uuorisalo, S, Haukipuro, K, Pokela, R, Sgrjala, H. Risk features for surgical-site infections in coronary artery bypass surgery. Infect Control Hosp Epidemiol 1998;19:240–247.CrossRefGoogle Scholar
32.Kahn, M, Steib, S, Fraser, V, Dunagan, W. Expert system for culture-based infection control surveillance. Proceedings: The Annual Symposium on Computer Applications in Medical Care. 1993;171–75.Google ScholarPubMed
33.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
34.Armitage, P, Berry, G. Statistical Methods in Medical Research. 3rd ed. Oxford, England: Blackwell Science; 1994.Google Scholar
35.Kleinbaum, DG, Kupper, LL, Morgenstern, H. Epidemiologic Research. Belmont, CA: Lifetime Learning Publishers; 1982.Google Scholar
36.Higgins, TL.Estafanous, FG, Loop, FD, Beck, GJ, Blum, JM, Paranandi, L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. JAMA 1992;267:2344–2348.CrossRefGoogle ScholarPubMed
37.Hosmer, DW, Lemeshow, S. Applied Logistic Regression. New York, NY: Wiley; 1989.Google Scholar
38.American Society of Health-System Pharmacists Commission on Therapeutics. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Clin Pharm 1992;11:483–513.Google Scholar
39.Page, CP, Bohnen, JM, Fletcher, R, McManus, AT, Solomkin, JS, Wittmann, DH. Antimicrobial prophylaxis for surgical wounds: guidelines for clinical care. Arch Surg 1993;128:79–88.CrossRefGoogle ScholarPubMed
40.Dellinger, EP, Gross, PA, Barrett, TL, Krause, PJ, Mortone, WJ, McGowan, JE Jr, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Clin Infect Dis 1994;18:422–427.CrossRefGoogle ScholarPubMed
41.Antimicrobial prophylaxis in surgery. The Medical Letter 1995;37:79–82.Google Scholar
42.Nichols, RL. Update: antibiotic prophylaxis in surgery. Infect Dis Clin Pract 1996;5(suppl 2):S77–S84.CrossRefGoogle Scholar
43.O'Conner, GT, Plume, SK, Olmstead, EM, Morton, JR, Maloney, CT, Nugent, WC, et al. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. JAMA 1996;275:841–846.Google Scholar