Clinical‐care protocol for preventing mediastinitis after coronary artery bypass graft surgery: A quality improvement initiative from a private hospital

摘要

Abstract Background Surgical site infections after cardiac surgery are associated with severe outcomes, including reoperation and death. We aimed to describe the effect of a standardized clinical‐care protocol for preventing mediastinitis in patients who underwent coronary artery bypass graft surgery (CABG). Methods In a hospital certified by Joint Commission International, all patients who underwent CABG from January 2011 to December 2016 were compared in two periods according to the moment of implementation of a standardized clinical‐care protocol for prevention of mediastinitis (CCPPM): pre‐protocol (January 2011‐December 2012) and post‐protocol (January 2013‐December 2016). The CCPPM consisted of the patient using a kit containing chlorhexidine 2% for bathing, mupirocin 20?mg/g for nasal topical use and chlorhexidine 0.12% for oral hygiene for 5 days before surgery, in addition to prophylaxis with a glycopeptide antimicrobial and strict glucose control (110‐140?mg/dL) during surgery and immediate postoperative. Results We evaluated 1760 patients who underwent CABG in both periods. The occurrence of mediastinitis before protocol implementation was 1.44% (10 of 692 CABG). After the implementation of the protocol, there was an important reduction in the incidence of mediastinitis to 0.09% (1 of 1068 CABG) ( P ?=?0.002). Although we did not observe a significant difference in mortality between the groups (2.3% vs 1%, P ?=?0.77), there was fewer in‐hospital mortality due to mediastinitis after the CCPPM (0.2% vs 0%, P ??0.001). Conclusion Implementation of a standardized CCPPM was associated with a significant reduction in the incidence of mediastinitis after CABG and reduction of mortality in the group of patients with mediastinitis.