Sternal wound infection Flashcards
What is incidence
0.75 % to 2.4%
Staphylococcues aureus and coagulase negative staphylococci are the most commonly found microorganisms
coagulase negative staph–colonize from normal skin flora, likely in obese, COPD, slow growing.
What is definition of DSWI
One of the following
1. presence of an oraganism islated from culture of mediastinal fluid
2. evidence of mediatinitis seen during operation
and 3) one of the following conditions
a. chest pain, sternal instability, fever > 38,
What are risk factors
Obesity Diabetes mellitus COPD * prolonged intubation has been shown to one of the most signfican renal failure smoking heart failure older age male Prolonged hospital stay IABP use of both IMA Excessive bone wax Prolonged up times/Reexploration/transfusion/
Methods to prevent DSWI
Smoking cessation, weight loss Perioperative intranasal application of mupirocin Skin preparation before surgery Hair removal (clipping) Prophylactic antbiotecis Control of blood glucose leves closure that ensurs sternal stability skeletonized ITA
Surgical repair options
Primary closure and irrigation
Soft tissues flaps
omental
pectoralis major
rectus abdominin
Vacuum-assisted closure therapy
Ways to decrease sternal wound infection
Shower with Chlorhexidine gluconate on the evening and morning before surgery
Prophylactic intranasal application of mupirocin given BID before and for 5d after
Hair clipping the morning of surgery
Prophylactic antibiotics
Tight control of blood sugars
Minimizing operative times
Avoidance of excessive use of electocautery
