Surgical Site Infection guidelines[edit | edit source]
Preoperative[edit | edit source]
- Soap and Water Bath, Hair Shampoo (all patients) night prior to surgery
- Additionally followed by a Chlorhexidine (CHG) Bath night before surgery <32 weeks gestation
- Clean gown & Clean ECG Leads (inpatients)- if possible
Intraoperative[edit | edit source]
Timing of Antibiotic
- Cefazolin/Ancef administered within 0-60 minutes prior to incision (3-5 minute push)
Skin Antisepsis
- Initial wash (after positioning)
- CHG or soap and water (< 2 kg and/or < 2 months and patients with CHG sensitivity/allergy)
Just prior to incision
- 8% Povidone-Iodine for patients < 2 kg and/or < 2 months and patients with CHG sensitivity/allergy
- 2% CHG for patients ≥ 2 kg and 2 months and patients with Povidone-Iodine allergy
- Allowed to dry for 3 minutes prior to draping
Postoperative[edit | edit source]
Postoperative Antibiotics
· Discontinued 24 hours postoperatively or when chest tube removed
Sternal Dressing Change
- The skin layer for cardiac surgical incisions is closed with absorbable sutures and surgical glue (optional) .
- First postoperative thoracotomy dressing change is performed on POD #2. This ensures the original sterile dressing placed at the time of chest closure is maintained for at least 48 hours.
- Following the first dressing removal, thoracotomy wounds are covered with gauze and tape. On POD #5, the wound can be maintained without a dressing. At any time if there is risk of wound contamination or injury, it should be covered with gauze and tape and changed when soiled.
- thoracotomy wound dressings are performed using aseptic technique.
- Prior to any postoperative echocardiogram, thoracotomy wound is covered with guaze and an occlusive, transparent dressing. Following the procedure, the gel should be cleaned from the chest and abdomen and the surgical dressing removed.
- Any signs of thoracotomy wound infection or dehiscence (redness, tenderness, drainage, pain, swelling, incision separation) is assessed and managed
- Avoid draping telemetry leads or any other equipment over the incision if leaving open to air.
- Surgical glue should not be removed, rather it will fall off the wound spontaneously.
- Non-absorbable Chest tube sutures are removed 10-14 days after wound closure, if discharged can be done at first visit. *might want to consider using absorbale sutures for CT sights.
References[edit | edit source]
- Cannon, M., Hersey, D., Harrison, S., Joy, B., Naguib, A., Galantowicz, M., & Simsic, J. (2016). Improving Surveillance and Prevention of Surgical Site Infection in Pediatric Cardiac Surgery. American Journal of Critical Care, 25(2), e30–e37.
- Caruso, T. J., Wang, E. Y., Schwenk, H., Marquez, J. L. S., Cahn, J., Loh, L., Shaffer, J., Chen, K., Wood, M., & Sharek, P. J. (2019). A Postoperative Care Bundle Reduces Surgical Site Infections in Pediatric Patients Undergoing Cardiac Surgeries. The Joint Commission Journal on Quality and Patient Safety, 45(3), 156–163.
- Delgado-Corcoran, C., Van Dorn, C. S., Pribble, C., Thorell, E. A., Pavia, A. T., Ward, C., Smout, R., Bratton, S. L., & Burch, P. T. (2017). Reducing Pediatric Sternal Wound Infections. Pediatric Critical Care Medicine, 18(5), 461–468.
- Galvin, P. (2009). Reducing surgical site infections in children undergoing cardiac surgery: A nurse-led initiative at one hospital has dramatic results. American Journal of Nursing, 109 (12), 49-55.
- Hodge, A. B., Thornton, B. A., Gajarski, R., Hersey, D., Cannon, M., Naguib, A. N., Joy, B. F., & McConnell, P. I. (2019). Quality Improvement Project in Congenital Cardiothoracic Surgery Patients. Pediatric Quality and Safety, 4(4), e188.
- Woodward, C.S., et al. (2012). Prevention of sternal wound infection in pediatric cardiac surgery: A protocolized approach. World Journal for Pediatric and Congenital Heart Surgery, 3, 463-469.
- Woodward, C., Taylor, R., Son, M., Taeed, R., Jacobs, M. L., Kane, L., Jacobs, J. P., & Husain, S. A. (2017). Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients. World Journal for Pediatric and Congenital Heart Surgery, 8(4), 453–459.
- Woodward, C. S., Son, M., Calhoon, J., Michalek, J., & Husain, S. A. (2011). Sternal Wound Infections in Pediatric Congenital Cardiac Surgery: A Survey of Incidence and Preventative Practice. The Annals of Thoracic Surgery, 91(3), 799–804.