How to Prevent Cardiac Surgical Wound Infections (Video)

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Your doctor told you that you need heart surgery, so you did your homework, researching how to best select your heart surgeon and hospital. Although you don’t choose a hospital solely on reported data, one of the criteria you probably reviewed during that process was the rate of surgical site infections (SSIs) reported after cardiac surgery. Recent data show that SSIs are the most common healthcare-associated infections, accounting for 31 percent of all hospital-acquired infections among hospitalized patients. You can research how your chosen hospital is doing when it comes to SSIs by looking at its Quality Performance Report like this one for Cleveland Clinic.

Safety is our highest priority with any patient and procedure, and we want you to have a speedy recovery. Here’s how you and your doctor can reduce the chance you’ll develop a wound infection following heart surgery.

Antibiotics

Historically, your plan of attack actually begins one hour before your surgery with an antibiotic given in a vein in your arm—called a “prophylactic” or preventive antibiotic. As the Chairman of the Thoracic and Cardiovascular Surgery department here at Cleveland Clinic, I participated in a study we reported here in 2012 that determined that further “refinement” of antibiotic timing could significantly lower surgical wound infections overall—post-surgical infections can be particularly problematic. So that you don’t become resistant to antibiotics used for your heart surgery, they will be stopped approximately 24 hours after your procedure. In certain cases, they may be continued longer, but there’s no real scientific evidence that using them longer is any more effective.

Hair removal

Removing hair at the surgical site is an important part of your surgery preparation, and is best done right before your surgery, at the site of the incision in your skin. When hair removal occurs way before surgery, you might develop infections in the tiny, difficult-to-see cuts that occur with any hair removal. Recent studies have shown that clippers are generally safer than razors, which may increase the probability of SSIs.

Risk factors

It’s important to assess your risk prior to heart surgery to prevent possible complications. These risk factors include:

  • Excess body weight

    Because a number of medical conditions associated with obesity—and especially severe obesity—may increase risks for cardiac surgery, your doctor may advise you to lose weight prior to your surgery if time allows.

  • Diabetes

    To lower your risk of infection, you’ll want to have your blood under control before heart surgery.

  • Wound care

    Part of taking care of yourself includes taking excellent care of your wound after cardiac surgery. You received discharge instructions, so be sure you understand them and ask questions if you don’t.

    You may have had larger incisions in both your breast bone and your chest, or a minimally-invasive, smaller incision, plus small incisions on other parts of your body. It’s important to stay vigilant about observing all those sites to check for infection, and keeping your hands clean when you do. Always follow instructions for bathing and showering, and never hesitate to call your doctor with any questions.

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Joseph F. Sabik III, MD

Joseph F. Sabik III, MD, is Chairman of the Department of Thoracic and Cardiovascular Surgery at Cleveland Clinic and directs the Clinic’s Cardiothoracic Training Program.