Reducing surgical site infection rates in cardiac surgery: results of 10-year infection control programme
Abstract number: P1904
Finkelstein R., Rabino G., Mashiach T., Bar-El Y., Adler Z., Kerztman V., Cohen O., Milo S.
Background: To report the results of an infection control program on surgical site infections (SSIs) complicating cardiac operations.
Methods: Prospective cohort study of patients undergoing cardiac operations. Interventions included prospective surveillance, povidone-iodine scrub showers, depilation before surgery, administration of preoperative antibiotic prophylaxis in the operating room and comprehensive postdischarge follow-up. Infections were evaluated using CDC's definitions. Logistic regression models were fitted to assess infection rates over time, adjusting for factors known to affect SSI rates (NNIS risk index category, type of operation, sex, age, emergency operation, administration of preoperative antibiotic prophylaxis, length of stay in hospital before surgery).
Results: 3,249 consecutive procedures were evaluated from January 1st, 1997 to December 31, 2006. Rates of deep incisional SSIs remained low, but unchanged over the study period (mean 1.8%). The rate of superficial incisional SSIs (SUP), all organ/space infections (OS), and mediastinitis (MED) during the first two years were 4.7%, 3.1%, and 2.22, respectively and they decreased to 2.6%, 1.31%, and 0.19, respectively by the end of 2002 (p = 0.04, 0.07, 0.02). The rate of SSIs due to methicillin-resistant S. aureus (MRSA) decreased from 1.48% to 0.75% (p = 0.25). The adjusted odds ratios (OR) for these infections at the end of 2002 compared to December 31, 1998, were as follow: SUP 0.5 (95% confidence interval [CI-95], 0.260.97, OS 0.44 (CI-95, 0.392.08), MED 0.09 (CI-95, 0.0120.73), and MRSA 0.49 (CI-95, 0.151.64, respectively. The 1-year mortality rate among patients with SSIs was 8.3% as compared with a mortality rate of 4.6% among non-infected patients. By logistic regression analysis, SSI remained an independent risk associated with an increased mortality (OR 1.8; CI-95, 1.122.93).
Conclusions: We observed significant reductions in infection rates in most types of infections, particularly in superficial SSI and mediastinitis. These differences remained significant when adjusted for potential confounding variables.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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