A protocol designed to prevent sternal wound infections
in children after cardiac surgery successfully decreased the number of
Cathy S. Woodward, DNP, RN, and colleagues at the
University of Texas Health Science Center, San Antonio, conducted the study
because there were concerns about the number of sternal wound infections they
were seeing in their unit.
“There are currently no protocols or guidelines
available that address the reduction of sternal wound infections in
children,” Woodward, assistant professor in the department of pediatrics,
told Cardiology Today. “Instead, people are pulling protocols from
the adult world and seeing if they work in children.”
The pediatric protocol developed included preoperative
baths with a skin disinfectant; use of single patient-use electrodes; attention
to timing of preoperative antibiotics; and specialized care of the infant with
delayed sternal closure.
“From the moment the child comes into our hospital
to the time they leave, we have a whole series of steps to reduce
infection,” Woodward said.
A prospective study was conducted during a 2-year period
to follow protocol adherence and the incidence of all levels of sternal wound
infections. The results of the study were presented at the 16th Annual Update
on Pediatric and Congenital Cardiovascular Disease.
During the study period, 308 children aged younger than
18 years had stenotomies. Between the first and second years of the study, the
researchers noted a trend toward reduction in superficial, deep and organ space
sternal wound infections (8.8% in year 1 vs. 3.4% in year 2; P=.059).
Risk for sternal wound infection was associated with delayed sternal closure
(OR=5.1; 95% CI, 2.09-14.26). Use and adherence to the protocol on children with
delayed sternal closure was associated with a trend toward decreased
infections during year 2 of the study (25.9% in year 1 vs. 8%
in year 2).
“Initiating strategies to reduce sternal wound
infections with a focus on children with delayed sternal closure may result in
improved overall infection rates. A multicenter study of a protocolized
approach to sternal wound infection is needed,” the researchers concluded.
This study was a follow-up to an initial nationwide
study carried out in 2009. In the initial study, no standardized manner to
prevent sternal wound infections was found in programs across the country.
– by Casey Murphy
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Disclosure: Ms. Woodward reports no relevant