Abstract 01
Xiuhua Z. Bell, MS, RN, CCRN, CSC
Peninsula Regional Medical Center
pxhbell@gmail.com
Title: Risk Factors for Sternal Wound Infections after Open Heart Surgery
Objectives (of project and/or presentation):
1. Identify the common risk factors for sternal wound infections (SWIs) after cardiac surgery.
2. Identify the Evidence-Based Practice (EBP) driven interventions to reduce identified risk factors for SWIs.
Introduction: Sternal wound infections (SWI) are one of the most devastating and costliest complications of
cardiothoracic surgery. It is imperative for Cardiothoracic Intensive Care Unit (CTICU) nurses to understand risk
factors that contribute to SWI and to implement evidence-based practice (EBP) changes to decrease infection risk.
In the first quarter of 2012, Peninsula Regional Medical Center (PRMC) saw a dramatic increase in SWIs; the rate
was 4.39%, significantly higher than the 2.55% CDC benchmark. In response, EBP changes were implemented in
the cardiothoracic surgery service line. The purpose of this project was to review current practice at PRMC, to
explore EBP and clinical practice guidelines related to SWI prevention, and to review all patients who developed
SWI for common risk factors.
Methods: A retrospective, descriptive design was used. Institutional review board approval was obtained. Current
policies and EBP changes related to sternal wound care were reviewed. The medical records of all cardiothoracic
surgical patients with SWIs from 2012-2014 were explored. Descriptive analyses and correlations were conducted
using SPSS.
Results: After implementation of EBP changes, the 2012 second quarter SWI rate was 2.25%, the third quarter rate
was 1.32%, and fourth quarter was 0%. In 2013 the rate was 1.81% and, it was 0.23% in 2014. There were a total
of 15 cases of SWI. The most common risk factors included: increased age, male gender, bilateral internal
mammary artery used, longer bypass time, higher body-mass-index, low ejection-fraction, smoking, blood
transfusions, co-morbidities, and on inotrope(s) and the ventilator > 24 hours. Despite practice changes, the
written dressing protocol was outdated and needed revision.
Conclusions: Implementing EBP changes to minimize risk factors for SWI not only saves patients from severe
complications, it also saves medical institutions significant healthcare dollars (Greco, et al., 2015). Nurses can
implement EBP changes to improve cardiothoracic surgery patient outcomes.
References:
1.Bryan, C. S., Yarbrough, W. (2013). Preventing deep wound infection after coronary artery bypass grafting. Texas
Heart Institute Journal, 40 (2), 125-139.
2. Buja, A., Zampieron, A., Cavalet, S., Chiffi, D., Sandona P., Vinelli, A., Baldivin, T., & Baldo, V. (2012). An update
review on risk factors and scales for prediction of deep sternal wound infections. International Wound Journal, 9,
372-386. doi: 10.1111/j.1742-481X.2011.00896.x.
3. Filsoufi, F., Gastillo, J., Rahmanian, P.B., Broumand, S.R., Silvay, G., Carpenter, A., & Adams, D. (2009).
Epidemiology of deep sternal wound infection in cardiac surgery. Journal of Cardiothoracic and Vascular
Anesthesia, 23, 488-494. doi:10.1053/j.jvca.2009.02.007
4. Greco, G., Shi, W., Michler, R., Meltzer, E. D., Ailawadi, G., Hohmann, S. F. … & Gardner, T. J. (2015). Costs
associated with health care–associated infections in cardiac surgery. Journal of the American College of Cardiology,
65(1): 15–23. doi:10.1016/j.jacc.2014.09.079
Funding Source: None