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Results of a Comprehensive Infection Control Program for Reducing Surgical-Site Infections in Coronary Artery Bypass Surgery

Published online by Cambridge University Press:  02 January 2015

Samuel J. McConkey ,
Paul B. L'Ecuyer ,
Denise M. Murphy ,
Terry L. Leet ,
Thoralf M. Sundt  and
Victoria J. Fraser
Samuel J. McConkey
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Paul B. L'Ecuyer
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Denise M. Murphy
Affiliation:
Department of Infection Control, Barnes Hospital, St Louis, Missouri
Terry L. Leet
Affiliation:
Center for Healthcare Quality and Effectiveness, BJC Health System, St Louis, Missouri
Thoralf M. Sundt
Affiliation:
Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, 660 South Ave, Box 8051, St Louis, MO 63110
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Abstract

Objective:

To evaluate the efficacy of a comprehensive infection control program on the reduction of surgical-site infections (SSIs) following coronary artery bypass graft (CABG) surgery.

Design:

Prospective cohort study.

Setting:

1,000-bed tertiary-care hospital.

Patients:

Persons undergoing CABG with or without concomitant valve surgery from April 1991 through December 1994.

Interventions:

Prospective surveillance, quarterly reporting of SSI rates, chlorhexidene showers, discontinuation of shaving, administration of antibiotic prophylaxis in the holding area, elimination of ice baths for cooling of cardioplegia solution, limitation of operating room traffic, minimization of flash sterilization, and elimination of postoperative tap-water wound bathing for 96 hours. Logistic regression models were fitted to assess infection rates over time, adjusting for severity of illness, surgeon, patient characteristics, and type of surgery.

Results:

2,231 procedures were performed. A reduction in infection rates was noted at all sites. The rate of deep chest infections decreased from 2.6% in 1991 to 1.6% in 1994. Over the same period, the rate of leg infections decreased from 6.8% to 2.7%, and of all SSI from 12.4% to 8.9%. The adjusted odds ratio (OR) for all SSIs for the end of 1994 compared to December 31,1991, was 0.37 (95% confidence interval [CI95], 0.22-0.63). For deep chest and mediastinal infections, the adjusted OR comparing the same period was 0.69 (CI95, 0.28-1.71).

Conclusions:

We observed significant reductions in SSI rates of deep and superficial sites in CABG surgery following implementation of a comprehensive infection control program. These differences remained significant when adjusted for potential confounding covariables

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 8 , August 1999 , pp. 533 - 538
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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