Sternal wound care to prevent infections in adult cardiac surgery patients.

Sternal wound infection post-cardiac surgery is a serious complication that can lead to increased length of stay, substantial financial impact, and increased mortality. The occurrence of sternal wound infections has been reported from 0.4% to 4% of postoperative cardiac surgeries. It is imperative that every heart surgery program implements the best practice to prevent the detrimental effects of sternal wound infections. In an effort to improve the cardiothoracic (CT) surgery program in a community hospital, a decision was made to create a specialty floor including specialized nurses to care for open-heart surgery patients. In October 2010, a group of these nurses formed a working committee to explore ways to improve the overall care of our CT surgery patients. A vision and purpose for this committee were identified: (1) update and improve practice for CT surgery patients utilizing evidence-based standards, (2) successfully disseminate this information to all staff caring for the CT surgery patients, and (3) evaluate the impact of any practice changes on patient outcomes. An initial focus for the committee was to standardize sternal wound care among all staff members on the cardiovascular floors, cardiac care unit, and progressive care unit.

Hyperglycemia after cardiac surgery: improving a quality measure.

BACKGROUND: The Surgical Care Improvement Project #4 (SCIP#4) performance measure is used to evaluate achievement of target blood glucose control after cardiac surgery. OBJECTIVES: The purpose of this study was to identify patient characteristics and outcomes in patients undergoing cardiac surgery who met the SCIP#4 performance measure versus those who did not. METHODS: A retrospective case-control design was used. RESULTS: Preoperative hemoglobin A1C (HbA1C) level and history of diabetes were 2 major risk factors for failing to meet the SCIP#4 measure. A trend toward a longer length of stay was observed, mortality was 3 times more prevalent, and renal failure was 4 times more frequent in patients who did not meet the SCIP#4 quality measure. CONCLUSIONS: Not meeting the SCIP#4 measure is associated with adverse outcomes. History of diabetes and preoperative HbAIC level should be considered when evaluating strategies for managing postsurgical hyperglycemia.