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Prevention of Deep Sternal Wound Infection Through Tight Glycemic Control

Explore the multidisciplinary approach to develop and implement a tight glycemic control protocol to prevent deep sternal wound infections in cardiac surgery. Learn about the benefits, protocol goals, implementation process, and outcome measures.

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Prevention of Deep Sternal Wound Infection Through Tight Glycemic Control

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  1. Prevention of Deep Sternal Wound Infection Through Tight Glycemic ControlA 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 southcoast.org

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

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

  4. 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) southcoast.org

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

  6. Cardiac Surgery – All Deep Sternum Infection southcoast.org

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

  8. Patient Process Reviewed • Pre-op • Operating Room • CVICU • CVSD southcoast.org

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

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

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

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

  13. Implementation of the Protocol • Staff • Champion • Acceptance • Education • Compliance southcoast.org

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

  15. Quality Outcome Data 28 Months without a DSWI southcoast.org

  16. Work in Progress • Work team meetings • Subgroup meetings • Patient rounds • Data collection southcoast.org

  17. Questions southcoast.org

  18. 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/adultcardiacdb/datacollection/index.html southcoast.org

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