Clinical‐care protocol for preventing mediastinitis after coronary artery bypass graft surgery: A quality improvement initiative from a private hospital

Abstract

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‐care protocol 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. The occurrence 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.

Prehabilitation before elective coronary artery bypass grafting surgery: a scoping review

“…All studies included in this scoping review were published between November 1987 and September 2022, 4,10,12,18,39–101 33 (49%) of which were published in the past 10 years. Of the included studies, 59 (88%) had an intervention study design, 5 (7%) were observational, 73,74,80,84,99 2 (3%) were qualitative, 12,54 and 1 (2%) was mixed methods 48 .…”

“…Five studies 42,65,67,77,78 comprising 21,122 participants identified different types of preoperative oral health interventions: teeth and tongue brushing, oral rinsing and gargling with 15 mL chlorhexidine gluconate 12%, nasal decolonization, bathing with chlorhexidine 2%, nasal topical mupirocin, polyvidone iodine scrub, and octenidine nasal ointment. Mainly physical outcomes were examined, including postoperative pneumonia, sternal wound infection, mediastinitis, need for antibiotics postoperatively, mortality in hospital, and LOS.…”

“…NR 4. NR Formalizing the role of former cardiac surgery patients as peer support-givers for preoperative cardiac surgery patients may provide an important adjunct to preoperative teaching in this group. Macedo et al , 67 (2019) Brazil Clinical trial n=1760 CABG In-hospital Decolonization (clinical care protocol for prevention of mediastinitis) with chlorhexidine 2% for bathing, mupirocin 20 mg/g for nasal use and chlorhexidine 0,12% for oral hygiene once daily, for 5 days before surgery + prophylaxis with a glycopeptide antimicrobial and strict glucose control (110-140 mg/dL) during surgery. Followed by a nurse pre/post orientations of the operative wound and systematic evaluation of the patient to detect complications in the early phase. Physical Mediastinitis In-hospital mortality Psychological NR 1.…”

Levantamento Epidemiólogico Do Perfil Odontológico Dos Idosos Internados Em Uma Clínica Médica De Um Hospital Geral No Interior De Minas Gerais

“…Nesse contexto, é possível observar a importância que se faz o profissional Cirurgião Dentista (CD ) inserido dentro de um cenário multiprofissional, promovendo intervenções odontológicas que melhorem a condição de higiene oral de pacientes hospitalizados (GAETTI-JARDI et al, 2013;MARTÍN et al, 2018;FONSECA, 2019;MACEDO et al, 2019). É importante ressaltar que na cavidade oral existem áreas que facilitam a adesão de microrganismos, favorecendo a formação do biofilme.…”

“…É importante ressaltar que na cavidade oral existem áreas que facilitam a adesão de microrganismos, favorecendo a formação do biofilme. Sem a higiene bucal adequada, a quantidade e a patogenicidade do biofilme podem aumentar com o tempo de internação, podendo contribuir para a instalação ou agravamento das doenças bucais, disseminação de patógenos e estabelecimento de infecções nosocomiais (GAETTI-JARDI et al, 2013;KIM et al, 2017;RIJT et al, 2018;MACEDO et al, 2019;MACEDO et al, 2020). Assim, nota-se que o CD apresenta um papel fundamental na recuperação de pacientes hospitalizados.…”