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Analysis of Risk Factors for Sternal Surgical Site Infection Emphasizing the Appropriate Ventilation of the Operating Theaters

Published online by Cambridge University Press:  21 June 2016

Serap Simsek Yavuz ,
Yesim Bicer ,
Nihan Yapici ,
Sibel Kalaca ,
Osman Ozcan Aydin ,
Gercek Camur ,
Funda Kocak  and
Zuhal Aykac
Serap Simsek Yavuz*
Affiliation:
Departments of Infectious Disease and Clinical Microbiology, Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Uskudar, Istanbul, Turkey
Yesim Bicer
Affiliation:
Anesthesiology and Reanimation, Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Uskudar, Istanbul, Turkey
Nihan Yapici
Affiliation:
Anesthesiology and Reanimation, Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Uskudar, Istanbul, Turkey
Sibel Kalaca
Affiliation:
Department of Public Health, School of Medicine, Marmara University, Haydarpasa, Istanbul, Turkey
Osman Ozcan Aydin
Affiliation:
Anesthesiology and Reanimation, Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Uskudar, Istanbul, Turkey
Gercek Camur
Affiliation:
Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Uskudar, Istanbul, Turkey
Funda Kocak
Affiliation:
Departments of Infectious Disease and Clinical Microbiology, Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Uskudar, Istanbul, Turkey
Zuhal Aykac
Affiliation:
Anesthesiology and Reanimation, Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Uskudar, Istanbul, Turkey
*
Sevki Ozengin Sk. Ercan Apt. No: 16/4 81090 Erenkoy/Istanbul, ([email protected])
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Abstract

Objective.

To determine the incidence of and identify risk factors for sternal surgical site infection (SSI).

Design.

Prospective cohort study. Data on potential risk factors, including the type of operating theater and infection data, were collected prospectively and analyzed by multivariate analysis.

Setting.

Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, a 700-bed teaching hospital and the largest center for cardiac surgery in Turkey. The cardiothoracic unit performs approximately 3,000 cardiac operations per year.

Patients.

All adult patients who underwent cardiac surgery with sternotomy between January 14, 2002, and July 1, 2002, and who survived at least 4 days after surgery were included in the study.

Results.

Potential risk factor data were complete for 991 patients. There was sternal SSI in 41 patients (4.1%). Female sex, diabetes mellitus, operation performed in the older operating theaters, and duration of procedure exceeding 5 hours were identified as independent risk factors for sternal SSI.

Conclusions.

Female and diabetic patients are at higher risk for sternal SSI and should be followed up carefully after cardiac surgery to prevent the development of sternal SSI. Reducing the duration of surgery could reduce the rate of postoperative sternal SSI. The operating theater environment may have an important role in the pathogenesis of sternal SSI, and appropriate ventilation of the operating theaters would be critical in the prevention of sternal SSI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 9 , September 2006 , pp. 958 - 963
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Greenblatt, J, Fischer, RA. Complications of cardiac surgery: infections. In: Kotler, MN, Alfieri, A, eds. Cardiac and Noncardiac Complications of Open Heart Surgery: Prevention, Diagnosis and Treatment. New York: Futura; 1992:145–176.Google Scholar
2.Kollef, MH, Sharpless, L, Vlasnik, J, Pasque, C, Murphy, D, Fraser, V. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 1997; 112:666–675.CrossRefGoogle ScholarPubMed
3.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. In: Olmsted, RN, ed. APIC Infection Control and Applied Epidemiology: Principles and Practice. St. Louis: Mosby; 1996: A1–A20.Google Scholar
4.Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance system basic SSI risk index. Clin Infect Dis 2001; 33:S69–S77.Google Scholar
5.Kluytman, JAJW, Mouton, JW, Maat, APWM, Manders, MAAJ, Michel, MF, Wagenvoort, JHT. Surveillance of postoperative infections in thoracic surgery. J Hosp Infect 1994; 27:139–147.Google Scholar
6.Rebello, MH, Bernal, JM, Llorca, J, Rabasa, JM, Revuelta, JM. Nosocomial Infections in patients having cardiovascular operations: a multivariate analysis of risk factors. J Thorac Cardiovasc Surg 1996; 112:908–913.Google Scholar
7.NNIS National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992 to June 2002, issued August 2002. Am J Infect Control 2002; 30:458–475.Google Scholar
8.Russo, PL, Spelman, DW. A new surgical-site infection risk index using risk factors identified by multivariate analysis for patients undergoing coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2002; 23:372–376.CrossRefGoogle ScholarPubMed
9.Kohli, M, Yuan, L, Escobar, M, et al. A risk index for sternal surgical wound infection after cardiovascular surgery. Infect Control Hosp Epidemiol 2003;24:17–25.CrossRefGoogle ScholarPubMed
10.Vuorisalo, S, Haukipuro, K, Pokela, R, Syrjala, H. Risk features for surgical-site infections in coronary artery bypass surgery. Infect Control Hosp Epidemiol 1998; 19:229–33.Google Scholar
11.Bellchambers, J, Haris, JM, Cullinan, P, Gaya, H, Pepper, JR. A prospective study of wound infection in coronary artery surgery. Eur J Cardiothorac Surg 1999; 15:45–50.CrossRefGoogle ScholarPubMed
12.Rupp, ME. Mediastinitis. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005:170–178.Google Scholar
13.El Oakley, RM, Wright, JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg 1996; 61:1030–1036.Google Scholar
14.Bundy, JK, Gonzalez, VR, Barnard, BM, Hardy, RJ, DuPont, HL. Gender risk differences for surgical site infections among a primary coronary artery bypass graft surgery cohort. Am J Infect Control 2003; 31. Poster 151.Google Scholar
15.Kollef, MH, Copeland, M, Senkowski, C, et al. Macromastia as a factor in sternal wound dehiscence following cardiac surgery: management combining chest wall reconstruction and reduction mammoplasty. J Card Surg 1992; 7:275–278.Google Scholar
16.Ridderstolpe, L, Gill, H, Granfeldt, H, Ahlfeldt, H, Rutberg, H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001; 20:1168–1175.CrossRefGoogle ScholarPubMed
17.Zacharias, A, Habib, RH. Factors predisposing to median sternotomy complications. Deep vs superficial infection. Chest 1996; 110:1173–1178.Google Scholar
18.Olsen, M, Lock-Buckley, P, Hopkins, D, Polish, LB, Sundt, TM, Fraser, VJ. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg 2002; 124:136–145.Google Scholar
19.Trick, WE, Scheckler, WE, Tokars, JI, et al. Modifiable risk factors associated with deep sternal surgical site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2000; 119:108–114.Google Scholar
20.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR, the Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20:250–278.Google Scholar
21.Clark, RE, Amos, WC, Higgins, V, Bemberg, KF, Weldon, CS. Infection control in cardiac surgery. Surgery 1976; 79:89–96.Google ScholarPubMed
22.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.Google Scholar