This multicenter quality improvement project evaluated a protocol to prevent sternal wound infections in children who underwent cardiac surgery.

Nine pediatric cardiac programs prospectively collected compliance data on 4,198 patients who underwent sternotomy for cardiac surgery. The study team found improvements in days between infections (68.2 days pre–protocol vs. 130 post–protocol) and in infection rates (1.9 percent of children pre–protocol vs. 1.5 percent post–protocol).

One significant factor was the appropriate timing of pre–operative antibiotics, with significantly fewer infections when clinicians administered antibiotics within 60 minutes before the incision. There was a trend toward increased risk of infection among patients with delayed sternal closure for each day the sternum was open.

The researchers suggest that these patients may benefit from earlier closure, and recommend that future quality improvement projects address this issue.

The study was presented at the 20th Annual Update on Pediatric and Congenital Cardiovascular Disease.