Pediatric protocol reduced sternal wound infections after cardiac surgery

Cardiology 2012

A protocol designed to prevent sternal wound infections in children after cardiac surgery successfully decreased the number of infections.

Cathy S. Woodward, DNP, RN, and colleagues at the University of Texas Health Science Center, San Antonio, conducted the study because there were concerns about the number of sternal wound infections they were seeing in their unit.

“There are currently no protocols or guidelines available that address the reduction of sternal wound infections in children,” Woodward, assistant professor in the department of pediatrics, told Cardiology Today. “Instead, people are pulling protocols from the adult world and seeing if they work in children.”

The pediatric protocol developed included preoperative baths with a skin disinfectant; use of single patient-use electrodes; attention to timing of preoperative antibiotics; and specialized care of the infant with delayed sternal closure.

“From the moment the child comes into our hospital to the time they leave, we have a whole series of steps to reduce infection,” Woodward said.

A prospective study was conducted during a 2-year period to follow protocol adherence and the incidence of all levels of sternal wound infections. The results of the study were presented at the 16th Annual Update on Pediatric and Congenital Cardiovascular Disease.

During the study period, 308 children aged younger than 18 years had stenotomies. Between the first and second years of the study, the researchers noted a trend toward reduction in superficial, deep and organ space sternal wound infections (8.8% in year 1 vs. 3.4% in year 2; P=.059). Risk for sternal wound infection was associated with delayed sternal closure (OR=5.1; 95% CI, 2.09-14.26). Use and adherence to the protocol on children with delayed sternal closure was associated with a trend toward decreased infections during year 2 of the study (25.9% in year 1 vs. 8% in year 2).

“Initiating strategies to reduce sternal wound infections with a focus on children with delayed sternal closure may result in improved overall infection rates. A multicenter study of a protocolized approach to sternal wound infection is needed,” the researchers concluded.

This study was a follow-up to an initial nationwide study carried out in 2009. In the initial study, no standardized manner to prevent sternal wound infections was found in programs across the country. – by Casey Murphy

For more information:

Woodward CS. Abstract #463. Presented at: The 16th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 22-26, 2012; Orlando, Fla.

Disclosure: Ms. Woodward reports no relevant financial disclosures.

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