Improvement of Post-Operative Coronary Artery Bypass Graft Surgery Wound Infection Rates

Abstract

ISSUE: A devastating complication of coronary artery bypass graft (CABG) surgery is post-operative surgical site wound infections. In 2001, Baptist Medical Center (BMC) experienced a post-operative CABG surgical wound infection rate that was above the Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance System (NISS) rate. PROJECT: A multidisciplinary performance improvement team, consisting of the chiefs of Cardiovascular Surgery and Infectious Disease, the nurse epidemiologist, the diabetes educator, and the cardiovascular case manager, met to review cardiovascular surgery wound infection rates from 2001. After reviewing evidence-based literature, a gap analysis was performed to compare the hospital's historical experience of clinical practice regarding pre-operative, intra-operative, and post-operative care of the CABG surgical with national best practices. Five key clinical processes were identified: 1) hair removal at the surgical site by using clippers; 2) prophylactic antibiotic infusion time, 30–60 minutes prior to incision; 3) insulin infusion for 72 hours post-operatively for patients with hyperglycemia; 4) standardized post-operative wound care; and 5) use of antibiotic to nares. RESULTS: After these five clinical processes were implemented, the hospital's post-operative CABG surgical wound rate decreased by 57%, a decrease the hospital continues to maintain. The Joint Commission on Accreditation of Healthcare Organization (JCAHO) awarded BMC the Ernest A. Codman Award in November 2003. LESSONS LEARNED: It is possible, in a large tertiary-care center, to form a multidisciplinary performance improvement team that can impact patient outcomes. These clinical practice changes are now being instituted in other surgical services.