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Volume 112, Nº 6, June 2019


DOI: http://www.dx.doi.org/10.5935/abc.20190070


Surgical Site Infection Prevention Bundle in Cardiac Surgery

Lilian Silva de Andrade

Erci Maria Onzi Siliprandi

Larissa Lemos Karsburg

Francine Possebon Berlesi

Otávio Luiz da Fontoura Carvalho

Darlan Sebastião da Rosa

Rodrigo Pires dos Santos


Background: Surgical site infections (SSI) are among the most prevalent infections in healthcare institutions, attributing a risk of death which varies from 33% to 77% and a 2- to 11-fold increase in risk of death. Patients submitted to cardiac surgery are more susceptible to SSI, accounting for 3.5% to 21% of SSI. The mortality rate attributable to these causes is as high as 25%. Prevention of SSI in cardiac surgery is based on a bundle of preventive measures, which focus on modifiable risks.

Objective: The objective of this study was to identify SSI risk factors in clean cardiac surgery.

Methods: A retrospective cohort study analyzed 1,846 medical records from patients who underwent clean cardiac surgery. Fisher’s exact test was used for bivariate comparison, and Poisson regression was used for independent analysis of SSI risk, considering a significance level of p < 0.05.

Results: The results of the study comprised a multivariate analysis. The variables that were associated with the diagnosis of SSI were: surgical risk index (OR: 2.575; CI: 1.224–5.416), obesity (OR: 2.068; CI: 1.457–2.936), diabetes mellitus (OR: 1,678; CI: 1.168–2.409), and blood glucose level (OR: 1.004; CI: 1.001–1.007).

Conclusions: This study evidenced that complete adherence to the bundle was not associated with a reduction in the risk of surgical infections. Diabetes mellitus, obesity, and surgical risk index assessment were, however, identified to increase association and consequently risk of SSI in cardiac surgery. (Arq Bras Cardiol. 2019; 112(6):769-774)

Keywords: Cardiac Surgical Procedures; Adult; Risk Factors/prevention and control; Patient Care Bundles; Anti-Infective Agents; Surgical Wound Infection; Cross Infection.