Original Investigation

Clinical-Care Protocol for Preventing Mediastinitis After Coronary Artery Bypass Graft Surgery: A Quality Improvement Initiative From a Private Hospital

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Thiago A Macedo
Pedro G M de Barros E Silva
Anna S Machado
Denise L Ramos
Sheila F Souza
Mariana Y Okada
Rômulo B de Souza
Leandro de Oliveira Jardim
José C T Garcia
Valter Furlan
Coronary artery bypass graft surgery, mediastinitis, standardized protocol


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-careprotocol 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. Theoccurrence 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.

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Original Investigation
Author Biography

Corresponding Author

Thiago A Macedo, Department of Clinical Research, Hospital TotalCor, São Paulo, Brazil. Infection Control Service, Hospital TotalCor, São Paulo, Brazil.

Thiago A. Macedo,
Department of Clinical Research, Hospital TotalCor, Alameda Santos Street, 764, Jardim Paulista, São Paulo 01418-100, Brazil.
E-mail: thiago.cardio@gmail.com