Preventing Surgical Site Infection in Cardiovascular Surgery:Cooperation between the Infection Control Team and Surgeons

(Department of Cardiovascular Surgery, and Infection Control Team*, Kobe City Medical Center General Hospital, Kobe, Japan)

Yu Shomura Yukikatsu Okada Noriko Shinkai
Michihiro Nasu Hiroshi Fujiwara Tadaaki Koyama
Mitsuru Yuzaki Takashi Murashita Naoto Fukunaga
Yasunobu Konishi
Postoperative infections should be comprehensively controlled in the context of infection control, rather than as activities of individual surgeons. We started a surgical site infection(SSI)surveillance program in 2009 in which prophylactic measures for preventing SSIs were applied. These measures were as follows:1)screening for nasal carriage of methicillin-resistant Staphylococcus aureus;2)dental checks and oral screening;3)antibiotic prophylaxis in the intra- and postoperative period;4)control of glucose levels to ≦160mg/dl in the immediate postoperative period;and 5)early removal of surgical drain. After the introduction of prophylactic measures, we reexamined SSI surveillance and added the following prophylactic measures at the beginning of 2011:6)data concerning SSI and compliance with prophylactic measures for all surgical and ward staff were published monthly, and the Infection Control Team(ICT)and surgeons performed weekly ward visits to assess SSIs;7)recommendations were made for wearing two pairs of gloves and surgical hoods to cover the hair, scalp, ears and neck;and 8)collaboration with diabetologists was implemented to control glucose levels in diabetics. We compared incidences of SSI in cardiovascular surgery from the periods before(469 cases, Group B)and after(118 cases, Group A)introduction of the additional prophylactic measures. Clinical characteristics of patients in each group did not differ significantly. Operative time was significantly shorter in Group A(400±116min)than in Group B(434±145min). Compliance with antibiotic prophylaxis in the intraoperative period improved progressively from 93% in Group B to 99% in Group A. Compliance with control of glucose levels to ≦160mg/dl on postoperative day 1 improved progressively from 71% in Group B to 81% in Group A. Duration of drain placement was significantly shorter in Group A(2.9±1.8days)than in Group B(3.6±2.9days). Incidence of SSI decreased significantly from 6.0% in Group B to 0.8% in Group A. Revision of preventive measures based on the results of surveillance and enhancement of cooperation between the ICT and surgeons could help to decrease the incidence of SSI.
  Jpn. J. Cardiovasc. Surg. 42:377-383(2013)

Keywords:cardiovascular surgery, surgical-site infection, infection control team, surveillance, compliance with SSI prophylactic measures