EBPP – Sternal Incision Infection Rates
Maria Kurlenda
NURS 324
Annotated Bibliography
Horiuchi, T., Tanishima, H., Tamagawa, K., Sakaguchi, S., Shono, Y., Tsubakihara, H., & ...
Kinoshita, Y. (2010). A wound protector shields incision sites from bacterial invasion.
Surgical Infections, 11(6), 501-503.
doi:http://dx.doi.org.ezproxy.gvsu.edu/10.1089/sur.2009.072
A study was done on gastrointestinal surgical patients and the incidence of surgical site
infections. This study wanted to prove if a wound protector used during surgery helps to prevent
superficial surgical site infections. The results conclude that using a wound protector does in fact
protect an incision site from bacterial infection. The wound protectors also were shown to reduce
the damage to incision sites due to low temperature and low humidity atmosphere of operating
rooms in previous studies. According to this study irrigation with an antimicrobial agent is a very
good way to prevent surgical site infections. A wound protector from what I understand is
something that covers the skin around a surgical incision which prevents bacteria from getting
into the surgical incision site. Irrigation was also done in these instances of a wound protector
being used. (Although this study was not done on open heart surgery patients, I would think that
this could be true for any incision on any part of the body.)
Hosseinrezaei, H. H., Rafiei, H. H., & Amiri, M. M. (2012). Incidence and risk factors of sternal
wound infection at site of incision after open-heart surgery. Journal Of Wound Care,
21(8), 408-411.
A study was conducted in an Iranian Critical Care Unit on Open Heart Surgery patients.
A descriptive, analytic study investigating every open-heart surgery patient from March 2010 to
March 2011 was done based on the incidence and risk factors of Sternal wound infection.
Infections may have occurred before, during and after the surgery. One investigator observed the
incision site on arrival to the Critical Care Unit, daily during the patients stay and on discharge
for any signs of infection. The findings of this study determined that this Critical Care Unit had a
high incidence of Sternal wound infections and thus the staff there needed more education. It was
found that some risk factors that cause Sternal wound infection are diabetes, age, gender,
hyperlipidemia, history of a respiratory disease such as COPD and history of an addiction to
opiates. 10% of all open heart patients on this unit acquired a Sternal wound infection.
Waldow, T., Szlapka, M., Hensel, J., Plötze, K., Matschke, K., & Jatzwauk, L. (2012). Skin
sealant InteguSeal((R)) has no impact on prevention of postoperative mediastinitis after
cardiac surgery. Journal Of Hospital Infection, 81(4), 278-282.
doi:http://dx.doi.org.ezproxy.gvsu.edu/10.1016/j.jhin.2012.04.024
A study was done to see if using a skin sealant called InteguSeal ® being used before
Sternal incisions were made during open heart surgery would decrease the incidence of incision
infection and mediastinitis. A group with normal hospital pre-procedure prep was used and in the
other group, the InteguSeal® skin prep was used and the two groups were compared based on
Sternal wound infection and mediastinitis rates. The two groups had an even number of
participants. The results of this study was that the use of InteguSeal ® did not lower the
incidence of Sternal wound infection of mediastinitis. Sternal wound infections relate to a higher
mortality rate in open heart patients. According to this article, some patient dependent risk
factors are present in every open heart patient populations such as age, female sex, obesity,
hypertension, diabetes mellitus, obstructive lung disease and dietary deficits.
1. Purpose (all reasoning has a purpose)
2. Questions at issue or central problem (all
reasoning is an attempt to figure
something out, to settle some question,
solve some problem)
Does Sternal incision infection rates depend
on something that was done before, during or
after surgery? Can infections be prevented by
nursing care?
To decrease the infection rate on post surgery
patients with an incision. What before, during
or after surgery may cause an incision
infection.
3. Point of view (all reasoning is done from
some point of view; think about the
stakeholders)
My point of view is from the nursing
standpoint and looking at the readmission of
patients due to incision infections.
4. Information (all information is based on
The only information I have right now is
data, information, evidence, experience, based on what we are doing on the unit I work
research)
on. We have been using soap and water baths
if a new basin is used with each bath or use the
pre-packaged disposable cloths instead. Does
using a wound protector, skin prep or
something else help to prevent incision
infections after open heart surgery?
5. Concepts and ideas (all reasoning is
The concept of not using a soap water and
expressed through, and shaped by,
basin bath is to prevent the growth of bacteria
concepts and ideas)
in a basin that is used over again everyday of a
patient's stay in the hospital. Using a new clean
basin or using pre-packaged disposable wipes
do not grow bacteria so possibly this will
reduce infection rates.
6. Assumptions (all reasoning is based on
It is assumed based on logical thinking of how
assumptions-beliefs we take for
bacteria grows that reusing the same basin with
granted)
soap and water day in and day out could
possibly cause infection in incisions for postop patients.
7. Implications and consequences (all
Higher infection rates could be the
reasoning leads somewhere. It has
consequence of something we are doing
implications and when acted upon, has before, during or after surgery. This includes
consequences)
the physicians, OR staff, nursing staff before
and after surgery.
8. Inference and interpretation (all
As a nurse we have the duty to keep our
reasoning contains inferences from
patients safe and do things with the least
which we draw conclusions and give
amount of harm possible. It only makes sense.
meaning to data and situations)
to keep our patients free from infection if we
can possibly do something to do that.
Reflection on the EBPP
How did the planning process, where you thought about what you wanted to
change, prepare you for the EBPP?
The planning process was somewhat difficult because with a unit as big as the one I work
on and the number of patients leaves a lot of room for improvement. There were quite a few
things that I could have written my EBPP on but I tried to choose one that none of my peers
would have chosen. One that is specific to the type of patient I normally see is what I wanted to
choose.
How did the peer evaluation process prepare you for the EBPP?
I don’t think the peer evaluation process helped me at all. I had three peers comment on
my EBPP but not one of them actually used the rubric to evaluate me. The comments I received
were just opinions and not based on the rubric so pretty much it was like my EBPP was not
evaluated at all by my peers. That was frustrating because I had nothing to go by when I was
revising it. I had to just guess that I did things right.
Do you feel you are prepared to elicit change in your practice with your proposal?
How does it fit into quality health care?
The infection rate of our sterna incisions is always a top priority on my unit. I believe that
if I could show enough evidence that what I propose would make our infection rate decrease, I
could elicit change. This of course would take a long time to do on such a large unit with a large
number of employees, but is possible. Some change on this topic has been talked about on my
unit but not much has changed yet. I could possibly be the person to begin that change in my
own personal practice every day. The one thing that is on my side on this issue is that my unit is
aware that we do have a problem and it needs to be fixed so what I propose may be taken
seriously since something has to be done. I would love to be the beginning of a lowered infection
rate in our open heart patients.
What could you have done better?
I should have chosen a broader topic because it was really hard to find any articles that
went exactly with what I proposed. I kind of had to change my proposal to go with the articles I
found in order for it to work. I still used my topic and my own ideas about what to change in my
current practice but not exactly what I wanted to explore. This was the most difficult part for me.
How well do you think you are using the EOR? Do they make sense to you (why or
why not?)
This is the first time I have ever used the EOR so I know I am probably not utilizing it to
its full potential. I hope to understand it more once I use it more. I like the fact that I have to see
the opposing side of an opinion that I may have. This makes me look at the full picture and not
be so biased by an opinion that I have formed. I believe the EOR makes sense to me if I actually
understand it correctly. I do not know it well enough to just use it on my own, but one day
maybe it will come to that. More practice with the EOR is needed for me to fully understand and
be able to use it on my own without prompts. I do believe that it is a very useful tool if one
knows how to use it correctly.