gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Sustainable decrease of deep sternal surgical site infection rates by a comprehensive infection control program

Nachhaltige Senkung sternaler Wundinfektionsraten durch ein multimodales Infektionskontrollprogramm

Meeting Abstract

  • K. Graf - Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover, Germany
  • D. Sohr - Charité – Universitätsmedizin Berlin, Institut für Hygiene und Umweltmedizin, Berlin, Germany
  • A. Haverich - Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
  • C. Kühn - Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
  • P. Gastmeier - Charité – Universitätsmedizin Berlin, Institut für Hygiene und Umweltmedizin, Berlin, Germany
  • I.F. Chaberny - Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocINF 10-4

DOI: 10.3205/10kit020, URN: urn:nbn:de:0183-10kit0205

Veröffentlicht: 2. Juni 2010

© 2010 Graf et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objectives: Deep sternal surgical site infections (DSSI) represent a severe complication in cardiac surgery. Following an increasing incidence of DSSI, a case control study was performed to identify risk factors and infection control measures were reinforced. The aim was to initiate a comprehensive interdisciplinary model to prevent DSSI and to keep infection rates on a low level during a long-term period.

Methods:

Infection control measures: The following infection control measures were reinforced: MRSA screening, intranasal mupirocin use, antiseptic body washing, use of oral antiseptics, hair clipping, education of staff, improvement of application of antibiotic prophylaxis, change of surgical gloves after sternotomy and sternal wiring, modification of wound dressing and covering the wound primarily for 48 hours.

Risk factor analysis: The following risk factors were assessed for multivariate analysis: diabetes mellitus, BMI >25, COLD, renal insufficiency, nicotine abuse, immunosuppression, length of hospital stay preoperatively, ASA Score, wound contamination class, duration of extracorporal circulation, application of antibiotic prophylaxis, levels of blood glucose, duration of mechanical ventilation, length of ICU stay and total length of stay.

Results: Overall 4576 patients were included in the surveillance of a tertiary care hospital.

Infection control measures: The arrangements of infection prevention were accepted very well by health care workers. A significant decrease of DSSI from 3.61% (CI95 2.98–4.35) to 1.83% (CI95 1.08–2.90) was shown after implementation of the new arrangements). In total low infection rates were sustainable due to several interventions from 2007 until 2010.

Risk factor analysis: 120 cases and 120 controls were included. The primarily incidence density was 5.71 (95%CI 4.70–7.00) infections per 1,000 patient days.

Significant risk factors of DSSI were age >68 years, diabetes mellitus and intraoperative blood glucose level >8 mmol/L Preoperative antibiotic and extubation on the day of surgery were associated with a lower DSSI risk.

Conclusions: Clinicians should be aware of the risk factors for surgical site infections in cardiac surgery by surveillance. Continuing improvement in the infection control management may significantly reduce the rate of infection and may have a sustainable effect.