A continuous insulin infusion (CIII) protocol has been used for five years in the cardiac surgery population to reduce the risk of sternal wound infections. However, this protocol had never been evaluated for level of reduction of glucose levels and adherence by the caregivers. A retrospective chart review  of  all glucose levels in  157  and 155  patients in two consecutive  studies revealed  alarming high glucose levels ,  non-adherence  in the use of  the CIII protocol and a  3 % sternal wound infection rate. In addition, the CIII was inconsistently discontinued  in diabetic and non – diabetic patients resulting in confusion and frustration with the patients, nurses. and physicians. Consequently, a team consisting of physicians, physician assistants, staff nurses, clinical nurse specialists, dieticians, doctoral students and perfusionists met weekly to develop a systematic, evidence – based approach for treating hyperglycemia from admission to discharge in the cardiac surgery patient.  This resulted in the development of a CIII nomogram based on the results of the retrospective chart review of the first two studies, revision of  the post-op cardiac surgery diet , pre-operative assessment of  the hemoglobin A1C , a transition protocol  on post-operative day three  from CIII  to correctional coverage   and a discharge plan for glycemic control. Also, the quarterly sternal wound infection rate decreased to  1.5 %.  The third study is now in completion to further evaluate the effectiveness of the CIII.  In conclusion this collaborative interdisciplinary team approach is being utilized to develop evidence-based systematic protocols to reduce  blood stream infections and ventilator related pneumonia in the cardiac surgery population.