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Tight Glycemic Control Reduces Deep Sternal Wound Infection Rate Following Cardiac Surgery: A Multidisciplinary Approach Using a Novel Tool
Robert S Kramer1, Robert Groom1, Reed D Quinn1, Paul Lennon2, Denise Weldner1, Paulette Gallant1, Cheryll St. Onge1, Joanne Chapman1, Barb Heyl1, Ryan Knapp3, Anna Arnold3, Mirle A Kellett, Jr.4
1Division of Cardiothoracic Surgery, Maine Medical Center, Portland, ME;2Division of Cardiac Anesthesia, Maine Medical Center, Portland, ME;3Center for Evaluative Clinical Sciences at Dartmouth, Hanover, NH;4Division of Cardiology, Maine Medical Center, Portland, ME

1. Objective: To demonstrate the multidisciplinary interactions and tools required to effect changes in the processes of care in order to achieve tight glycemic control (TGC) and reduce the incidence of deep sternal wound infection (DSWI) rates in patients undergoing cardiac surgery.
2. Design: A retrospective cohort analysis comparing the rate of DSWI before and after implementing a multidisciplinary TGC initiative.
3. Setting: A cardiac surgical program in a tertiary care community hospital in New England
4. Patients: 3,065 consecutive adult cardiac surgical patients operated upon during the three years between January 1, 2004 and December 31, 2006
5. Interventions: Evidence was presented to the multidisciplinary group caring for cardiothoracic surgery patients demonstrating the relationship between hyperglycemia and DSWI. In addition, special emphasis was placed on nursing feedback and inservice training. A cumbersome glycemic management text protocol was replaced with a novel color-coded bedside tool (nomogram) to guide the bedside management of hyperglycemia. Subsequently, an algorithm for the transition to a home regimen was developed which further improved standardization of care and ease of management.
6. Main Outcome Measures: Hourly blood glucose monitoring and the incidence of DSWI.
7. Results: Eighteen months after the new program was initiated, the DSWI rate decreased by over 60% from 2.62% to 1.0%, when compared to the previous eighteen months. ( p< 0.001)
8. Conclusion: A TGC program using a novel tool in a multidisciplinary setting was successfully and safely established resulting in sustained improvement in the DSWI rate.


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