Introduction

Abstract

The discovery of microbes and the basics of microbiology in the 19th century, with the subsequent development of antiseptic routines, is one of the cornerstones of modern surgery. Despite the enormous progress made since then, postoperative surgical site infection (SSI) remains one of the most common and clinically important complications after an operation (1). Cardiac surgery, normally performed via median sternotomy, is no exception (2). Median sternotomy is a surgical procedure that offers many advantages, such as an excellent surgical exposure with high safety and reproducibility, and comparatively little postoperative pain and discomfort. However, although new treatment modalities have been introduced (3), postoperative sternal wound infection (SWI), especially deep infection with mediastinitis, is still a potentially very serious complication—and great efforts should be made to avoid it. A prerequisite for any effective prevention is acknowledgment of the problem. There may be several reasons why surgeons have not always recognised the true incidence or the huge medical and financial impact of postoperative SSI. Not only logistical reasons and but also psychological and—unfortunately—financial incentives for denial of different kinds of complications may exist. Furthermore, collaboration between different professional and scientific communities is required to first of all get a true picture of the situation, which is crucial for effectively addressing infectious complications, and secondly to pursue the multidisciplinary research required for new advancements. We therefore decided to arrange a Nordic Workshop on Prevention of Sternal Wound Infection, which was held in Stockholm, Sweden, 23 November 2006. The workshop gathered together interested cardiac surgeons, microbiologists and specialists in infectious diseases from Sweden and the other Nordic countries with the aim of reviewing current scientific knowledge, exchanging experiences with respect to new techniques, discussing future goals, and encouraging increased multidisciplinary contacts and collaboration in this field. One third of the meeting reviewed the subject from the perspective of different countries and specialities, and one third was used for an update on recent studies and clinical experiences of local application of collagen-gentamicin products in the wound for primary prevention of SWI. The final third of the meeting comprised a workshop where all participants actively joined in group discussions. These three topics were discussed: Whether or not there is at present sufficient data to support the use of local collagen-gentamicin prophylaxis (4). Whether or not it is possible (or desirable) to achieve uniform follow-up of postoperative SSI after cardiac surgery in the Nordic countries. Whether or not it is time for a national Swedish Mediastinitis Registry and, if so, what the aim and design of such a registry should be. This is a report of the meeting. Each speaker has prepared a manuscript of his or her presentation. In the following these manuscripts are presented separately with only minor editing by the above-mentioned authors, followed by a summary of the discussions and conclusions of the workshop.