Silver-Impregnated Dressings for Sternotomy Incisions to Prevent Surgical Site Infections in Children

Staveski, Sandra; Abrajano, Claire; Casazza, May; Bair, Ellen; Quan, Hanson; Dong, Emily; Petty, Amy; Felix, Katie; Roth, Stephen J.

doi:10.4037/ajcc2016843

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Pediatric Critical Care| September 01 2016

Silver-Impregnated Dressings for Sternotomy Incisions to Prevent Surgical Site Infections in Children

Sandra Staveski, RN, PhD, CPNP-AC;

Sandra Staveski, RN, PhD, CPNP-AC

Sandra Staveski is an assistant professor, Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Claire Abrajano, May Casazza, and Ellen Bair are nurse practitioners and Hanson Quan, Emily Dong, Amy Petty, and Katie Felix are cardiovascular surgery physician assistants, Lucile Packard Children’s Hospital Stanford, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is a professor, Department of Pediatrics, and chief, Division of Pediatric Cardiology, at the Stanford University School of Medicine. He is a pediatric cardiac intensivist and director, Children’s Heart Center, at Lucile Packard Children’s Hospital Stanford.

Corresponding author: Sandra Staveski, rn, phd, cpnp-ac, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (E-mail: [email protected]).

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Claire Abrajano, RN, MS, WOCN, RNFA, CPNP;

Claire Abrajano, RN, MS, WOCN, RNFA, CPNP

Sandra Staveski is an assistant professor, Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Claire Abrajano, May Casazza, and Ellen Bair are nurse practitioners and Hanson Quan, Emily Dong, Amy Petty, and Katie Felix are cardiovascular surgery physician assistants, Lucile Packard Children’s Hospital Stanford, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is a professor, Department of Pediatrics, and chief, Division of Pediatric Cardiology, at the Stanford University School of Medicine. He is a pediatric cardiac intensivist and director, Children’s Heart Center, at Lucile Packard Children’s Hospital Stanford.

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May Casazza, RN, MS, CPNP;

May Casazza, RN, MS, CPNP

Sandra Staveski is an assistant professor, Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Claire Abrajano, May Casazza, and Ellen Bair are nurse practitioners and Hanson Quan, Emily Dong, Amy Petty, and Katie Felix are cardiovascular surgery physician assistants, Lucile Packard Children’s Hospital Stanford, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is a professor, Department of Pediatrics, and chief, Division of Pediatric Cardiology, at the Stanford University School of Medicine. He is a pediatric cardiac intensivist and director, Children’s Heart Center, at Lucile Packard Children’s Hospital Stanford.

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Ellen Bair, RN, MS, CPNP;

Ellen Bair, RN, MS, CPNP

Sandra Staveski is an assistant professor, Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Claire Abrajano, May Casazza, and Ellen Bair are nurse practitioners and Hanson Quan, Emily Dong, Amy Petty, and Katie Felix are cardiovascular surgery physician assistants, Lucile Packard Children’s Hospital Stanford, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is a professor, Department of Pediatrics, and chief, Division of Pediatric Cardiology, at the Stanford University School of Medicine. He is a pediatric cardiac intensivist and director, Children’s Heart Center, at Lucile Packard Children’s Hospital Stanford.

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Hanson Quan, PA;

Hanson Quan, PA

Sandra Staveski is an assistant professor, Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Claire Abrajano, May Casazza, and Ellen Bair are nurse practitioners and Hanson Quan, Emily Dong, Amy Petty, and Katie Felix are cardiovascular surgery physician assistants, Lucile Packard Children’s Hospital Stanford, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is a professor, Department of Pediatrics, and chief, Division of Pediatric Cardiology, at the Stanford University School of Medicine. He is a pediatric cardiac intensivist and director, Children’s Heart Center, at Lucile Packard Children’s Hospital Stanford.

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Emily Dong, PA;

Emily Dong, PA

Sandra Staveski is an assistant professor, Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Claire Abrajano, May Casazza, and Ellen Bair are nurse practitioners and Hanson Quan, Emily Dong, Amy Petty, and Katie Felix are cardiovascular surgery physician assistants, Lucile Packard Children’s Hospital Stanford, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is a professor, Department of Pediatrics, and chief, Division of Pediatric Cardiology, at the Stanford University School of Medicine. He is a pediatric cardiac intensivist and director, Children’s Heart Center, at Lucile Packard Children’s Hospital Stanford.

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Amy Petty, PA;

Amy Petty, PA

Sandra Staveski is an assistant professor, Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Claire Abrajano, May Casazza, and Ellen Bair are nurse practitioners and Hanson Quan, Emily Dong, Amy Petty, and Katie Felix are cardiovascular surgery physician assistants, Lucile Packard Children’s Hospital Stanford, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is a professor, Department of Pediatrics, and chief, Division of Pediatric Cardiology, at the Stanford University School of Medicine. He is a pediatric cardiac intensivist and director, Children’s Heart Center, at Lucile Packard Children’s Hospital Stanford.

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Katie Felix, PA;

Katie Felix, PA

Sandra Staveski is an assistant professor, Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Claire Abrajano, May Casazza, and Ellen Bair are nurse practitioners and Hanson Quan, Emily Dong, Amy Petty, and Katie Felix are cardiovascular surgery physician assistants, Lucile Packard Children’s Hospital Stanford, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is a professor, Department of Pediatrics, and chief, Division of Pediatric Cardiology, at the Stanford University School of Medicine. He is a pediatric cardiac intensivist and director, Children’s Heart Center, at Lucile Packard Children’s Hospital Stanford.

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Stephen J. Roth, MD, MPH

Sandra Staveski is an assistant professor, Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Claire Abrajano, May Casazza, and Ellen Bair are nurse practitioners and Hanson Quan, Emily Dong, Amy Petty, and Katie Felix are cardiovascular surgery physician assistants, Lucile Packard Children’s Hospital Stanford, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is a professor, Department of Pediatrics, and chief, Division of Pediatric Cardiology, at the Stanford University School of Medicine. He is a pediatric cardiac intensivist and director, Children’s Heart Center, at Lucile Packard Children’s Hospital Stanford.

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Am J Crit Care (2016) 25 (5): 402–408.

https://doi.org/10.4037/ajcc2016843

Background

The consequences of surgical site infections can be severe and range from short-term delays in discharge from the hospital to life-threatening infections such as mediastinitis.

Objectives

To evaluate the effectiveness of silver-impregnated dressings in decreasing surgical site infections in children after cardiac surgery.

Methods

A randomized, controlled trial was used to compare silver-impregnated dressings (59 participants) with standard dressings (58 participants). The study team supervised all dressing changes after a sternotomy and ensured adherence with the hospital’s bundle for reduction of surgical site infections. The ASEPSIS tool was used to evaluate sternal wounds for evidence of infection.

Results

The 2 groups had comparable Risk Adjustment for Congenital Heart Surgery scores, age, sex, weight, height, operating room characteristics, and number of chest tubes and/or pacemaker wires. No surgical site infections occurred in any study participant. Infections did occur, however, during the same period, in cardiac surgical patients who were not enrolled in the study.

Conclusions

The evidence did not support the superiority of silver-impregnated dressings for prevention of surgical site infections in children after cardiac surgery. Adherence to a bundle for prevention of surgical site infections may have decreased the incidence of such infections in the study population during the study period.

2016

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