Surveillance and prevention of surgical site infections (SSIs) is becoming increasingly
important as the number of surgical procedures performed in the United States rise.
Despite improvements in technology and infection prevention best practices, SSI's
are major cause of morbidity and mortality. It is estimated that half of SSIs are
preventable by applying evidence-based strategies, including systemic surveillance
with attention to multiple factors, including patient risk factors, procedural risk
factors, and risk factors related to the hospital environment. In one Minnesota hospital
active surveillance for infections following coronary artery bypass grafts ceased
at the end of 2017 due to low incidence of infection. The following fall, through
passive surveillance, Infection Preventionists detected an increase in surgical site
infections following cardiac procedures. Cases were analyzed for similarities and
active surveillance was reinitiated.
Through surveillance for methicillin-susceptible Staphylococcus aureus (MSSA) in sterile
sites, two deep incisional primary SSI's were detected in patients in September 2018
following coronary artery bypass grafts (CBGs). Using the definitions provided by
the National Healthcare Safety Network (NHSN) all cardiac procedures performed at
this facility between April 1st and September 30th, 2018 were reviewed for additional
The review revealed an additional four SSI's following CBGs: Two superficial incisional
primary infections and one superficial incisional secondary infection. As a result,
the SSI rate associated with CBG surgeries for that time period increased to 4.84/100
procedures, above the target rate of ≤1.0/100 procedures. Four of 6 (67%) infections
were a result of Staphylococcus aureus raising concern for improper nasal decolonization
practices prior to surgery. Infection Preventionists engaged the Cardiac Surgery Council
to discuss infection prevention best practices before and during surgical procedures.
Continued surveillance for SSI's following cardiac procedures is a necessary means
of preventing infections in a facility and detecting breaches in infection control
during surgical procedures.