Prevention of Deep Sternal Wound Infection Through Tight

Prevention of Deep Sternal Wound Infection Through Tight Glycemic Control A Team Approach Debra Santilli MBA RN CCRN NE-BC Director of Cardiac Surgical Services Charlton Memorial Hospital Emmanuel Resendes RN BSN CCRN CSC Resource Nurse CVICU Charlton Memorial Hospital 1 southcoast. org 10/25/2020

Objectives • To identify ramifications of deep sternal wound infections. • To identify a multidisciplinary approach to developing, implementing, and measuring a tight glycemic control protocol. 2 southcoast. org 10/25/2020

Charlton Memorial Hospital • Cardiac Surgery Program • April 2002 • Over 1500 cases to date 3 southcoast. org 10/25/2020

Deep Sternal Wound Infection (DSWI) • Infection involving muscle, bone, and/or mediastinum. • Wound opened with excision of tissue (I&D) or re-exploration of mediastinum. • Positive culture • Antibiotic therapy (Gold J. , 2008) 4 southcoast. org 10/25/2020

Ramifications of DSWI • Increased mortality • Increased length of stay • Altered quality of life • Increased resource utilization 5 southcoast. org 10/25/2020

Cardiac Surgery – All Deep Sternum Infection 6 southcoast. org 10/25/2020

Multidisciplinary Team Composition • Cardiac Surgeon • • Cardiac Anesthesiologist • Pharmacist • Perfusionists 7 CVSD Resource Nurse • Endocrinologist • Physician Assistants • Infection Control Manager • CVOR Team • Quality Outcomes • CVICU Resource Nurse • Data Analyst southcoast. org 10/25/2020

Patient Process Reviewed • Pre-op • Operating Room • CVICU • CVSD 8 southcoast. org 10/25/2020

Team Goals • Develop an evidence based protocol to achieve tight glycemic control. • Implement the tight glycemic control protocol. • Set quality outcomes and monitor. 9 southcoast. org 10/25/2020

Evidence Based Practice Dr. Justin Carr • “Tight glucose control markedly improves acute outcomes…. including lowering the risk of infection. ” (Carr, J. et al, 2005 ) 10 southcoast. org 10/25/2020

Tight Glycemic Control Protocol Benefits • • 11 Decrease southcoast. org mortality complications length of stay resource utilization 10/25/2020

Protocol Goals • Early diagnosis of hyperglycemia • Target glucose level of 80 -130 mg/dl • Early peri-operative intervention • Continued post op management 12 southcoast. org 10/25/2020

Implementation of the Protocol • Staff • Champion • Acceptance • Education • Compliance 13 southcoast. org 10/25/2020

Outcome Measures • Glucose levels of 80 -130 mg/dl • Compliance with protocol • No evidence of sternal wound infections 14 southcoast. org 10/25/2020

Quality Outcome Data 28 Months without a DSWI 15 southcoast. org 10/25/2020

Work in Progress • Work team meetings • Subgroup meetings • Patient rounds • Data collection 16 southcoast. org 10/25/2020

Questions 17 southcoast. org 10/25/2020

References • Carr, J. M. (2005). Implementing tight glucose control after coronary bypass surgery. Annals of Thoracic Surgery. 80, 902 -909. • Gold, J. P. (2008). Data Collection: Adult Cardiac Surgery Data Collection. Retrieved June 17, 2008, from The Society of Thoracic Surgeons Web site: http: //www. sts. org/sections/stsnationaldatabase/datamanagers/adultcardiacd b/datacollection/index. html 18 southcoast. org 10/25/2020