Sternal wound infections during the COVID-19 pandemic: an unexpected benefit

Abstract

Background The novel coronavirus, now termed SARS-CoV-2, has had a significant impact on cardiac surgical services globally. Although drastically reduced, our institution has maintained a significant level of cardiac surgical activity during the pandemic. Rigorous COVID-19 guidelines have been instituted to mitigate the risk of viral transmission. We observed a reduction in sternal wound infections since the institution of new perioperative surgical guidelines. Methods We performed a retrospective analysis of all patients who underwent cardiac surgery at our institution since a national lockdown was declared in March 2020. A retrospective analysis of all patients who underwent cardiac surgery in the 12 months preceding the national lockdown, as a baseline cohort group, was also performed. Results A total of 2600 patients (493 during the COVID-19 pandemic) were included in this study. Urgent/emergency procedures accounted for more than 60% of procedures performed during the lockdown compared to 39% previously. During the COVID-19 pandemic, there were 4 sternal wound infections with an overall incidence of 0.8%. In comparison, the incidence of sternal wound infections was significantly higher at 3.0% in the 12-month period prior to lockdown with 63 sternal wound infections ( p = 0.006). Conclusion This report suggests a significant role of iatrogenic causes in sternal wound infections prior to the pandemic. The strict implementation of guidelines in the perioperative period suggests that sternal wound infections can be prevented. We propose that the now widespread COVID-19 guidelines to reduce transmission risk be adapted to help reduce the incidence of sternal wound infections.

Surgical site infections during the COVID-19 era: A retrospective, multicenter analysis

“…Our results may be congruent with the findings of Unterfrauner et al, that medical centers and surgical procedures with low rates of SSIs pre-COVID-19 may not benefit from additional infection prevention measures of perioperative COVID-19 precautions to the extent seen in centers and surgical procedures with historically higher rates of SSIs. 13 While the aforementioned small, retrospective, singlecentered studies provided hope that SSIs may be reduced early in the pandemic, [9][10][11]18 larger subsequent studies, including the findings herein, fail to demonstrate significant differences. Although counterintuitive, we observed no robust or statistically significant changes in SSI despite unprecedented changes in surgical workflow and PPE use.…”

“…Retrospective, single-centered studies from Italy, the United Kingdom, Germany, and Greece reported statistically significant reductions in SSIs following general surgery, cardiac surgery, neurosurgery, and colorectal surgery, respectively. [9][10][11]18 These findings are significant given that many of the surgical procedures performed following the COVID-19 shutdown were urgent/emergent in nature, conferring higher risk, while minor, elective procedures at low-risk of SSI were less commonly performed. A retrospective, propensity score matched study from India evaluated the risk of SSI following elective major oncologic surgery and reported that "increased compliance with hand hygiene, near-universal mask usage, and social distancing during the COVID-19 pandemic possibly led to 23% decreased odds of SSI in major oncologic resections."…”

“…3,8 Preliminary, small, single-center studies have shown mixed results regarding the impact of COVID-19 infection protocols on the rate of SSIs compared to historical cohorts. [9][10][11][12][13] The objective of this study was to evaluate the risk of postoperative SSIs in the COVID-19-era compared to a historical cohort at a large, multicenter, academic institution for inpatient colorectal, hysterectomy, hip prosthesis, and knee prosthesis surgeries.…”

Impact of a total lockdown for pandemic SARS-CoV-2 (Covid-19) on deep surgical site infections and other complications after orthopedic surgery: a retrospective analysis

“…Not quantified J Orthop Surg Res Zeng et al [ 18 ] 1.0% 1.0% SSI orthopaedic surgery in Shenzen, China Increased HAI Am J Infect Control McMullen et al [ 19 ] Baseline 100% 157–279% Increase in urinary tract infections Am J Infect Control McMullen et al [ 19 ] Baseline 100% 327–420% Catheter-related bloodstream infections Hand hygiene compliances Am J Infect Control Moore et al [ 25 ] 46% compliance 56% compliance No data on HAI or SSI; 19 hospitals in USA Clin Microbiol Infect Israel et al [ 6 ] 46% compliance 80% compliance No data on HAI or SSI; Covid-Units in Jerusalem J Primary Care Comm Health Roshan et al [ 7 ] unreported baseline 80–95% No data on HAI or SSI. Mention of their reduction Am J Infect Control Wee et al [ 17 ] 85% 100% Reduction of selected HAI and of MRSA transmission …”

“…The SSI risk was significantly lower during the lockdown [ 16 ]. Similarly, a study in the field of cardiac surgery showed significantly lower rates of sternal wound infections in 493 patients operated during lockdown compared to patients with surgical intervention in the twelve months preceding the lockdown [ 17 ]. All authors attributed this to intensified precautions and additional SSI preventing measures including wear of protective equipment and surgical masks, reduction of present staff during surgery, shortened hospital stay, decontamination and isolation between patients, and restriction of visitors at the hospital.…”