Pediatric cardiac surgical site infections: A single-center quality improvement initiativeCentral MessagePerspective
Nhat Chau, HBSc,
Crystal Tran, HBSc, CCRP,
Megan Clarke, MN, RN, CIC,
Jennifer Kilburn, MN, RN,
Cecilia St. George-Hyslop, MEd, RN, CNCCPC,
Diana Young, RN,
Sandra L. Merklinger, MN-NP, PhD,
Erica Mosolanczki, MN-NP,
Vivian Trinder, MN-NP,
Jill O'Hare, MN-NP,
Karen Clarke, RN,
Kate McCormick, MScN, RN,
Rachel D. Vanderlaan, MD, PhD, FRCSC
Affiliations
Nhat Chau, HBSc
Faculty of Art and Science, University of Toronto, Toronto, Ontario, Canada
Crystal Tran, HBSc, CCRP
Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
Megan Clarke, MN, RN, CIC
Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
Jennifer Kilburn, MN, RN
Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
Cecilia St. George-Hyslop, MEd, RN, CNCCPC
Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
Diana Young, RN
Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
Sandra L. Merklinger, MN-NP, PhD
Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
Erica Mosolanczki, MN-NP
Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
Vivian Trinder, MN-NP
Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
Jill O'Hare, MN-NP
Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
Karen Clarke, RN
Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
Kate McCormick, MScN, RN
Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
Rachel D. Vanderlaan, MD, PhD, FRCSC
Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Address for reprints: Rachel D. Vanderlaan, MD, PhD, FRCSC, Division of Cardiovascular Surgery, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada.
Objective: Pediatric cardiac surgery site infections (SSI) represent significant morbidity. Our institution reported elevated SSI rates of 3.48 per 100 cases over a 5-year period above target rates of 2.5 per 100 cases. Therefore, as a quality improvement initiative, we implemented interventions with the goal of decreasing SSI rates by 30%. Methods: Pediatric cardiovascular surgery patients (January 2021 to August 2023) who had SSI within 30 days of index operation were included (n = 1514) based on the National Healthcare Safety Network definition. Descriptive statistics were used to compare our preintervention cohort (pre-IV) (January 2021 to April 2022; n = 753) and postintervention cohort (post-IV) (May 2022 to August 2023; n = 761). Results: In the post-IV cohort, we found a significant decrease in total SSI (1.97 SSIs per 100 cases [15 out of 761]) versus pre-IV (3.85 SSIs per 100 cases [29 out of 753]), demonstrating a 48% reduction (P = .029). In our post-IV cohort, there was a significant reduction in superficial SSIs (pre-IV, 3.19 SSIs per 100 cases [24 out of 753] vs post-IV, 1.58 SSIs out of 100 cases [12 out of 761]; P = .04). Wounds presenting at 1 to 3 weeks were also reduced in our post-IV cohort (pre-IV, 2.66 SSIs per100 cases [20 out of 753] vs post-IV, 0.66 SSIs per 100 cases [5 out of 761]; P = .002). A significant reduction in SSIs in nonneonates was also noted (pre-IV, 2.79 SSIs per 100 cases [21 out of 753] vs post-IV, 0.92 SSIs per 100 cases [7 out of 761]; P = .007). Additionally, there was a significant reduction in SSIs associated with the Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery Congenital Heart Surgery 1 mortality category (P = .033) and the number of readmissions in the post-IV cohort (P = .042). Conclusions: A new surgical site dressing and multidisciplinary surveillance plan effectively reduced the overall burden of SSI rates at our institution. Future studies will address risk factors in specific subpopulations to further reduce SSIs at our institution.
