A rational approach to improving deep sternal wound infection rates post cardiac surgery

Michelle Kim1, Edward Buratto1, Kelly Williams2, Paul Simpson2, Eugene Athan2, Siven Seevanayagam1

1Department of Cardiothoracic Surgery, Barwon Health VIC Australia

2Department of Infectious Disease and Prevention, Barwon Health VIC Australia


Deep sternal wound infections (DSWI) following cardiac surgery is associated with significant morbidity, resource consumption and increased risk of mortality. Our cardiothoracic service was identified as an outlier for DSWI in the national cardiac surgery audit (ANZSCTS) database over a period of 4 years (2012-2015). Quality and safety improvement initiatives were undertaken at our service to reduce the incidence of DSWI.

The ANZSCTS database was used to determine the clinical characteristics of patients with DSWI between 2012 and 2015. A literature review was conducted to identify best practice for prevention and management of DSWI. A service-wide audit was performed using a Safety-II approach† to define and evaluate our current practice against best practice.

The annual incidence of DSWI from 2012 to 2015 at our service (1.75%) was greater than 2 standard deviations from the national average (1.01%). Pre-operative, operative and post-operative practices associated with DSWI were identified and improved (i.e. pre-operative patient preparation, antibiotic prophylaxis protocols, operating environment, technical factors and post-operative management). A re-audit was performed from 2016 to 2017 to evaluate impact. The incidence of DSWI decreased to 1.25% (n=4/319) and 1.30% (n=4/307) in 2016 and 2017 respectively.

The causes for DSWI are multifactorial and early results from a systematic quality improvement audit focusing on multiple aspects of our practice are promising. Guidelines and protocols have been updated to ensure the continuation of evidence-based best practice for DSWI at our service.

†Hollnagel, E 2014, Safety-I and safety-II: the past and future of safety management


Michelle is currently a Cardiothoracic Registrar working in Geelong, Victoria Australia.

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