Increase in Post-Coronary Artery Bypass Graft Surgical Site Infections (SSIs) Following Cease of Active Surveillance Demonstrates Need for Continued Active Surveillance for SSIs Following Cardiac Procedures

Abstract

BACKGROUND Surveillance and prevention of surgical site infections (SSIs) is becoming increasingly important as the number of surgical procedures performed in the United States rise. Despite improvements in technology and infection prevention best practices, SSI's are major cause of morbidity and mortality. It is estimated that half of SSIs are preventable by applying evidence-based strategies, including systemic surveillance with attention to multiple factors, including patient risk factors, procedural risk factors, and risk factors related to the hospital environment. In one Minnesota hospital active surveillance for infections following coronary artery bypass grafts ceased at the end of 2017 due to low incidence of infection. The following fall, through passive surveillance, Infection Preventionists detected an increase in surgical site infections following cardiac procedures. Cases were analyzed for similarities and active surveillance was reinitiated. METHODS Through surveillance for methicillin-susceptible Staphylococcus aureus (MSSA) in sterile sites, two deep incisional primary SSI's were detected in patients in September 2018 following coronary artery bypass grafts (CBGs). Using the definitions provided by the National Healthcare Safety Network (NHSN) all cardiac procedures performed at this facility between April 1st and September 30th, 2018 were reviewed for additional infections. RESULTS The review revealed an additional four SSI's following CBGs: Two superficial incisional primary infections and one superficial incisional secondary infection. As a result, the SSI rate associated with CBG surgeries for that time period increased to 4.84/100 procedures, above the target rate of ≤1.0/100 procedures. Four of 6 (67%) infections were a result of Staphylococcus aureus raising concern for improper nasal decolonization practices prior to surgery. Infection Preventionists engaged the Cardiac Surgery Council to discuss infection prevention best practices before and during surgical procedures. CONCLUSIONS Continued surveillance for SSI's following cardiac procedures is a necessary means of preventing infections in a facility and detecting breaches in infection control during surgical procedures.