Optimizing Prevention of Healthcare-Acquired Infections After Cardiac Surgery

More than 400,000 coronary artery bypass grafting (CABG) procedures are performed every year
in the United States (U.S.). Patients undergoing CABG surgery are at risk for a number of
adverse sequelae, many of which impact survival and contribute to overall health-care costs.
Healthcare-acquired infections (HAIs), including pneumonia and superficial and deep sternal
wound infections, occur among 16% of CABG patients and elevate a patient's risk of mortality
and add excess upfront and long-term expenditures to the health care system.

A number of barriers prevent wide-scale improvements in HAl rates within the setting of CABG
surgery. While a number of HAl prophylaxis measures have been developed, these measures do
not fully encompass the set of practices that may impact a patient's risk of HAl. Identifying
cardiac surgery specific risk factors would serve as the foundation for targeted quality
improvement strategies. In the absence of definitive data concerning best practices, HAl
prophylaxis is variable across surgeons and institutions, resulting in unnecessary morbidity
and cost. Prior work has shown the value of implementing evidence-based protocols in the
general intensive care unit setting. To what extent the implementation of cardiac surgery
specific standardized practices results in lower HAl rates is uncertain. An understanding of
the effectiveness of this approach would certainly assist surgeons and institutions in
providing safer care to their patient populations.

Rates of HAIs vary from 0-26% across the 33 institutions performing CABG surgery in Michigan.
This application seeks to reduce this rate by identifying and subsequently implementing
standardized practices, and evaluating their impact on HAl rates. This study will be based on
the prospective data and regional quality improvement activities and infrastructure of the
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC).
We will evaluate the effectiveness of these standardized practices in reducing HAIs
regionally and relative to national rates during the same time period.

Our Aim is to identify patient risk factors and clinical practices associated with HAIs after
cardiac surgery.

We will use prospectively collected data housed within the MSTCVS-QC to reveal risk factors
that elevate a patient's risk of developing HAIs. The results of this analysis will form the
foundation for the development of standardized regional practices to reduce HAIs. We will
explore the effect of traditional patient-level measures (age, sex, comorbid conditions),
process measures (timing and selection of antibiotics, continuous insulin infusion,
transfusions), and surgical practices (use of bilateral internal mammary artery usage among
diabetics, vein harvesting approach).

Inclusion Criteria:

- Female and male adult patients 18 and over undergoing cardiac surgery within the state
of Michigan from January 1, 2011 through June 30, 2013.

Exclusion Criteria:

- Pregnant women,

- children,

- endocarditis