Golden Cassidy, Murphy Kathy, Rosenblum Joshua M, Eriksson Charlotta, Dunaway Parker, Lukacs Mary, Newberry Lisa, Gleason Michelle E, Calamaro Christina J, Basu Mohua, Chanani Nikhil K, Shashidharan Subhadra, Fundora Michael P
From the Emory University School of Medicine, Atlanta, Ga.
Division of Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga.
Pediatr Qual Saf. 2025 Jan 7;10(1):e785. doi: 10.1097/pq9.0000000000000785. eCollection 2025 Jan-Feb.
This project aimed to decrease surgical site wound infections (SSIs) to less than 1 per 100 cases in pediatric patients after cardiothoracic surgery.
A multidisciplinary workgroup was established to identify perioperative risk factors, and educational gaps and create a bedside quality improvement (QI) rounding group to monitor wounds. SSIs were defined according to the Centers for Disease Control National Healthcare Safety Network guidelines. Infection preventionists adjudicated infections as SSIs after an SSI huddle evaluated the case. A QI bundle was developed more than 2 eras: 2015 criteria included an enhanced hygiene bundle, scripted discharge telephone calls about wound care, and 2019 criteria identified SSI risk factors, developed an SSI-QI rounding team, created additional wound care education, and standardized wound care. Data were collected from January 2014 to December 2022 to assess SSI rates per 100 surgical cases, as well as clinically relevant short- and long-term outcomes.
From December 2014 to December 2022, there were 5,610 surgical cases evaluated in SSI-QI rounds. Compared with the preintervention cohort, SSI rates decreased significantly during the intervention (SSI per 100 cases 2.82; 95% confidence interval, 1.94-4.09) and postintervention (SSI per 100 cases 0.55; 95% confidence interval, 0.24-1.26). There were no increases in reoperations, postoperative major complications, or discharge mortality throughout the study.
SSI rates decreased below the goal of 1 per 100 surgical cases. Standardized wound dressings, improving hygiene compliance including bath compliance from 80% to 96.1%, multidisciplinary collaboration, bedside rounds, and postdischarge procedures contributed to lowering and sustaining low SSI rates.
本项目旨在将心胸外科手术后儿科患者的手术部位伤口感染（SSIs）降低至每100例病例少于1例。
成立了一个多学科工作组，以确定围手术期风险因素和教育差距，并创建一个床边质量改进（QI）巡诊小组来监测伤口。SSIs根据疾病控制中心国家医疗安全网络指南进行定义。在SSI碰头会评估病例后，感染预防专家将感染判定为SSIs。在两个以上时期制定了一个QI捆绑方案：2015年的标准包括强化卫生捆绑方案、关于伤口护理的书面出院电话，2019年的标准确定了SSI风险因素，组建了一个SSI-QI巡诊团队，开展了额外的伤口护理教育，并规范了伤口护理。收集了2014年1月至2022年12月的数据，以评估每100例手术病例的SSI发生率以及临床相关的短期和长期结果。
2014年12月至2022年12月，在SSI-QI巡诊中评估了5610例手术病例。与干预前队列相比，干预期间SSI发生率显著下降（每100例病例的SSI为2.82；95%置信区间，1.94 - 4.09），干预后（每100例病例的SSI为0.55；95%置信区间，0.24 - 1.26）。在整个研究过程中，再次手术、术后主要并发症或出院死亡率均未增加。
SSI发生率降至每100例手术病例1例的目标以下。标准化伤口敷料、将卫生合规性（包括沐浴合规性）从80%提高到96.1%、多学科协作、床边巡诊以及出院后程序有助于降低并维持低SSI发生率。
