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Report On A Successful Combat Against Deep Sternal Wound Infections.
Willem Stooker, Maurice A.P. Oudeman, Marie-Josť de Hartog-Dikhoff.
OLVG, Amsterdam, Netherlands.

Objective Deep sternal wound infection (DSWI) is a dreaded complication in cardiac surgery. In 2013 we had an unexpected high incidence of DSWI (3%). We analyzed the patients and the operative process and implemented a bundle of measures to combat this problem. Methods. All patients with DSWI after CABG were analyzed. Microorganisms (even on DNA level), surgical procedure, surgical team, Operating Room (OR) were recorded for every patient. The whole perioperative and operative process of the surgery was evaluated by an external team of microbiologists and hygienic nurses. The recommendations were effectuated by a team consisting of a cardiac surgeon, cardiac anesthesiologist, OR nurse, microbiologist and hygiene nurse. This resulted in a bundle of measures consisting of strict restriction of door movements, change of OR lights, changes in drape fixation, change in disinfectant. All infections were strictly recorded in our national database. Results. No factor could be identified on behalf of our analysis of the patients although coagulase negative staphylococci were the most encountered microbiological cause. The use of bilateral mammary artery grafting was not a risk factor in our study group. Diabetic patients showed a higher risk of DSWI. The effect of all the combined measures were successful. The incidence of DSWI fell to a number below the predicted incidence (0.9%). Conclusion: Our bundle of measures to diminish our DSWI complication rate was successful. Chlorhexidin 2% disinfection appears to be an effective agent against coagulase negative staphylococci.

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Endorsed by:
The Society of Thoracic Surgeons

Co-sponsored by:
Association of Physician Assistants in Cardiovascular Surgery (APACVS) The International Society for Minimally Invasive Cardiothoracic Surgery Japanese Association for Coronary Artery Surgery
Brazilian Society of Cardiovascular Surgery Fu-Wai Hospital of Beijing Indian Association of Cardiovascular-Thoracic Surgeons
Society for Cardiothoracic Surgery in Great Britain & Ireland