Sternal wound infection Flashcards

1
Q

What is incidence

A

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.

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2
Q

What are risk factors

A
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/
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3
Q

Methods to prevent DSWI

A
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
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4
Q

Surgical repair options

A

Primary closure and irrigation

Soft tissues flaps
omental
pectoralis major
rectus abdominin

Vacuum-assisted closure therapy

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5
Q

Ways to decrease sternal wound infection

A

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

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6
Q

What is definition of DSWI

A

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,

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