1. 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
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November 20, 2018

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

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

4. 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)
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November 20, 2018

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

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

7. 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
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November 20, 2018

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

9. 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.
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November 20, 2018

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

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

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

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

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

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

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

17. Questions
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November 20, 2018

18. References
Carr, J. M. (2005).Implementing tight glucose control after coronary bypass surgery. Annals of Thoracic Surgery. 80,
Gold, J. P. (2008). Data Collection: Adult Cardiac Surgery Data Collection. Retrieved June 17, 2008, from The Society of Thoracic Surgeons Web site:
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November 20, 2018