Debra Santilli MBA RN CCRN NE-BC Emmanuel Resendes RN BSN CCRN CSC

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Presentation transcript:

Debra Santilli MBA RN CCRN NE-BC Emmanuel Resendes RN BSN CCRN CSC Prevention of Deep Sternal Wound Infection Through Tight Glycemic Control A Team Approach Debra Santilli MBA RN CCRN NE-BC Director of Cardiac Surgical Services Charlton Memorial Hospital Emmanuel Resendes RN BSN CCRN CSC Resource Nurse CVICU southcoast.org November 20, 2018

Objectives To identify ramifications of deep sternal wound infections. To identify a multidisciplinary approach to developing, implementing, and measuring a tight glycemic control protocol. southcoast.org November 20, 2018

Charlton Memorial Hospital Cardiac Surgery Program April 2002 Over 1500 cases to date southcoast.org November 20, 2018

Deep Sternal Wound Infection (DSWI) Infection involving muscle, bone, and/or mediastinum. Wound opened with excision of tissue (I&D) or re-exploration of mediastinum. Positive culture Antibiotic therapy (Gold J., 2008) southcoast.org November 20, 2018

Ramifications of DSWI Increased mortality Increased length of stay Altered quality of life Increased resource utilization southcoast.org November 20, 2018

Cardiac Surgery – All Deep Sternum Infection November 20, 2018 Cardiac Surgery – All Deep Sternum Infection southcoast.org November 20, 2018

Multidisciplinary Team Composition Cardiac Surgeon Cardiac Anesthesiologist Perfusionists Physician Assistants CVOR Team CVICU Resource Nurse CVSD Resource Nurse Pharmacist Endocrinologist Infection Control Manager Quality Outcomes Data Analyst southcoast.org November 20, 2018

Patient Process Reviewed Pre-op Operating Room CVICU CVSD southcoast.org November 20, 2018

Develop an evidence based protocol to achieve tight glycemic control. Team Goals Develop an evidence based protocol to achieve tight glycemic control. Implement the tight glycemic control protocol. Set quality outcomes and monitor. southcoast.org November 20, 2018

Evidence Based Practice Dr. Justin Carr “Tight glucose control markedly improves acute outcomes…. including lowering the risk of infection.” (Carr, J. et al, 2005 ) southcoast.org November 20, 2018

Tight Glycemic Control Protocol Benefits Decrease mortality Decrease complications Decrease length of stay Decrease resource utilization southcoast.org November 20, 2018

Early diagnosis of hyperglycemia Target glucose level of 80-130mg/dl Protocol Goals Early diagnosis of hyperglycemia Target glucose level of 80-130mg/dl Early peri-operative intervention Continued post op management southcoast.org November 20, 2018

Implementation of the Protocol Staff Champion Acceptance Education Compliance southcoast.org November 20, 2018

Glucose levels of 80-130mg/dl Compliance with protocol Outcome Measures Glucose levels of 80-130mg/dl Compliance with protocol No evidence of sternal wound infections southcoast.org November 20, 2018

Quality Outcome Data 28 Months without a DSWI southcoast.org November 20, 2018

Work in Progress Work team meetings Subgroup meetings Patient rounds Data collection southcoast.org November 20, 2018

Questions southcoast.org November 20, 2018

References Carr, J. M. (2005).Implementing tight glucose control after coronary bypass surgery. Annals of Thoracic Surgery. 80, 902-909. Gold, J. P. (2008). Data Collection: Adult Cardiac Surgery Data Collection. Retrieved June 17, 2008, from The Society of Thoracic Surgeons Web site: http://www.sts.org/sections/stsnationaldatabase/datamanagers/adultcardiacdb/datacollection/index.html southcoast.org November 20, 2018