Paper
Saturday, 22 July 2006
This presentation is part of : Initiatives in the Acute Care Setting
Best Practice Interventions for the Reduction of Sternal Wound Infections in Coronary Artery Bypass Graft Patients
Vickie Hettenbaugh, RN, BSN, MS, Surgical Progressive Care Unit, Lee Memorial Health System, Fort Myers, FL, USA
Learning Objective #1: Identify best practice recommendations to minimize the risk of sternal wound infections post operatively for coronary artery bypass graft (CABG) patients.
Learning Objective #2: Describe positive patient outcomes resulting from practice changes to prevent infection in the CABG patient postoperatively.
Surgical site infections complicating coronary artery bypass graft (CABG) procedures are associated with significant increases in length of stay, hospitalization costs, and mortality, suggesting the need for improved infection control measures to reduce deep chest surgical site infection rates.  An increase in CABG patients’ surgical site infections was noted over three consecutive quarters at our health care institution.  Our evidence-based practice interdisciplinary team sought to determine “what are the best practice recommendations to minimize the risk of sternal wound infections pre-operatively, intra-operatively, and post-operatively for CABG patients?”  Upon review of nursing research literature, five nursing practice changes and three mechanisms to track compliance were identified to potentially reduce the infection rate.  Operating room antibiotic administration times, closer tracking of diabetes patients, and overall infection rates were tracked and monitored.  Practice changes focusing on timely operative antibiotic administration, utilizing continuous insulin infusion to maintain normal blood glucose levels, incision care, and the use of Hibaclens antimicrobial scrubs for patient cleansing.  Physician order sets addressing Glucommander usage and wound care were developed and communicated to staff.  A combination of interventions were implemented resulting in an immediate decrease in CABG patients’ sternal wound infections.  Since practice change implementation, reductions have been documented for consecutive quarters over a three-year period.  Rates as low as 0.0% have been documented and rates have not peaked over 2.2% for superficial and 1.5% for deep sternal wounds.  Results have been consistently lower than the national benchmark of 2.8% for deep sternal wounds.  Implementation of best practice recommendations designed to provide the best care for CABG patients postoperatively significantly improved patient outcomes related to sternal wound infection.

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See more of The 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)