Implementation of an evidence-based practice to decrease surgical site infection after coronary artery bypass grafting

• Published in: Journal of international medical research Vol. 47; no. 8; pp. 3491 - 3501
• Main Authors: Al Salmi, Hanadi, Elmahrouk, Ahmed, Arafat, Amr A, Edrees, Azzahra, Alshehri, Mashael, Wali, Ghassan, Zabani, Ibrahim, Mahdi, Nasser A, Jamjoom, Ahmed
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.08.2019; Sage Publications Ltd; SAGE Publishing
• Subjects: Anti-Infective Agents, Local - therapeutic use; Case-Control Studies; Chlorhexidine - analogs & derivatives; Chlorhexidine - therapeutic use; Coronary Artery Bypass - adverse effects; Coronary Artery Disease - surgery; Coronary vessels; Evidence-Based Practice - statistics & numerical data; Female; Follow-Up Studies; Health Plan Implementation; Heart surgery; Humans; Infections; Male; Middle Aged; Prognosis; Prospective Studies; Risk factors; Special Issue: Cardiothoracic Critical Care; Surgical site infections; Surgical Wound Infection - drug therapy; Surgical Wound Infection - etiology; Surgical site infection; evidence-based practice; propensity score matching; infection control; chlorhexidine gluconate; coronary artery bypass grafting
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060519836511

Objective Surgical site infection (SSI) is a serious complication after coronary artery bypass grafting (CABG). This study was performed to evaluate evidence-based practice and structured problem-solving to reduce SSI after CABG. Methods An infection control strategy including supervised chlorhexidine gluconate (CHG) showers was implemented from January 2017 to March 2018 for 119 patients undergoing CABG. The controls comprised 244 patients who underwent CABG from 2014 to 2016. Risk factors for SSI were identified, and a problem-focused strategy was used to control SSI. Propensity score matching was used to study the effect of CHG showers on SSI. Results SSI occurred in 25 patients (10.25%) in the control group, and the significant risk factors were the postoperative blood glucose level, transfer from an outside hospital, emergency operation, redo sternotomy, a higher American Society of Anesthesiologists score, and the duration of surgery. After implementation of the program, the SSI rate significantly decreased to 3.36%. Patients who had undergone preoperative CHG showers had a significantly lower SSI rate (1.69%) than the matched controls (13.56%). Conclusion SSI after CABG can be reduced using evidence-based practice and structured problem-solving to identify risk factors. A preoperative CHG shower is associated with a lower SSI rate after CABG.