ABSTRACT
Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.
ABSTRACT
AIM: The purpose of this study was to assess rates of and risk factors for deep sternal wound infection after coronary artery bypass grafting surgery. BACKGROUND: Deep sternal wound infection is one of the most devastating complications of cardiac surgery, resulting in multiple operative and non-operative procedures and increased hospital costs. DESIGN: A retrospective design using an existing coronary artery surgery database of adults (n=206) who had undergone coronary artery bypass grafting surgeries between January 2004-January 2006 at a university affiliated hospital, northern Jordan was used. METHOD: Multiple logistic regression analyses were used to asses rates of and risk factors for deep sternal wound infection. RESULTS: Deep sternal wound infection incidence rate was 22% of the total sample. Risk factors of deep sternal wound infection include: (1) diabetes (OR=0·317, p=0·048), (2) Obesity (OR=0·275, p=0·011), (3) duration of surgery (OR=4·22, p=0·032) and (4) use of intraaortic balloon pump (OR=0·033, p=0·001). CONCLUSION: The proposed model provides a preliminary indication of risk factors placing coronary artery bypass grafting patients at risk of DSWI. Further investigations and testing of the model are needed. RELEVANCE TO CLINICAL PRACTICE: Determining patients who are at risk of developing deep sternal wound infection after cardiac surgeries is the first step towards its prevention.
