https://doi.org/10.4081/monaldi.2023.2604
The impact of COVID-19 prevention measures on surgical wound infection rates post-cardiac surgery
Submitted: April 12, 2023
Accepted: June 10, 2023
Published: October 12, 2023
Accepted: June 10, 2023
Abstract Views: 672
PDF: 157
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The COVID-19 pandemic had a huge impact on medical services. Several measures have been implemented to reduce the risk of viral transmission. In this paper, we assessed the impact of these measures on surgical wound infection rates in post-cardiac surgery patients. Hypothesis testing was used to compare post-cardiac operation infection rates between the year prior to the COVID-19 pandemic being declared and the first 13 months of the pandemic. The infection rates in 969 patients with operations between 01/03/2019 and 29/02/2020 were compared to those of 925 patients with cardiac surgery between 01/03/2020 and 31/03/2021. Infection rates for various operative urgencies and infection types were analyzed. To compare infection rates, a two-tailed pooled z-test using the difference in infection proportions was performed. A 5% significance level was used, and only categories with at least 10 patients in both the pre-COVID and COVID populations were tested. For leg infections, only operations involving coronary artery bypass grafting were included. To ensure that any differences in outcomes were not due to differences in patient demographics resulting in unequal operative risks, Euroscore II values, a measure of cardiac operative risk, were compared between the pre-COVID and post-COVID cohorts. The Mann-Whitney U-test was used to determine whether the distributions of Euroscore II values were likely to be drawn from the same population. A significance level of 5% was used. A total of 1901 patients (932 during the COVID-19 pandemic) were included in this study. There was a significant reduction in post-operative infections for all patients undergoing cardiac surgery, from 4.3% of patients before COVID-19 to 1.5% during the pandemic. During the pandemic, fewer elective and more urgent operations were performed. This study suggests a significant role for iatrogenic causes in wound infections before the pandemic. The implementation of COVID-19 prevention measures by healthcare providers can reduce surgical infection rates. As COVID-19-related restrictions have been eased, we suggest maintaining them for healthcare providers to reduce the incidence of surgical wound infections.
Sharif M, Wong CHM, Harky A. Sternal wound infections, risk factors and management-how far are we? A literature review. Heart Lung Circ 2019;28:835-43.
Schiraldi L, Jabbour G, Centofanti P, et al. Deep sternal wound infections: Evidence for prevention, treatment, and reconstructive surgery. Arch Plast Surg 2019;46:291-302.
Cayci C, Russo M, Cheema F, et al. Risk analysis of deep sternal wound infections and their impact on long-term survival: a propensity analysis. Ann Plast Surg 2008;61:294-301.
Hever P, Singh P, Eiben I, et al. The management of deep sternal wound infection: literature review and reconstructive algorithm. JPRAS Open 2021;28:77-89.
Jayakumar S, Khoynezhad A, Jahangiri M. Surgical site infections in cardiac surgery. Crit Care Clin 2020;36:581-92.
World Health Organization. Global guidelines for the prevention of surgical site infection. Available from: https://apps.who.int/iris/handle/10665/277399.
World Health Organization. Patient safety. WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. Available from: https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf.
World Health Organization. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19): interim guidance, 19 March 2020. Available from: https://apps.who.int/iris/handle/10665/331498.
Honda H, Iwata K. Personal protective equipment and improving compliance among healthcare workers in high-risk settings. Curr Opin Infect Dis 2016;29:400-6.
Crabtree TD, Codd JE, Fraser VJ, et al. Multivariate analysis of risk factors for deep and superficial sternal infection after coronary artery bypass grafting at a tertiary care medical center. Semin Thorac Cardiovasc Surg 2004;16:53-61.
Ridderstolpe L, Gill H, Granfeldt H, et al. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001;20:1168-75.
Sears ED, Wu L, Waljee JF, et al. The impact of deep sternal wound infection on mortality and resource utilization: a population-based study. World J Surg 2016;40:2673-80.
Graf K, Ott E, Vonberg RP, et al. Economic aspects of deep sternal wound infections. Eur J Cardiothorac Surg 2010;37:893-6.
Phoon PHY, Hwang NC. Deep sternal wound infection: diagnosis, treatment and prevention. J Cardiothorac Vasc Anesth 2020;34:1602-13.
Pradeep A, Rangasamy J, Varma PK. Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing. Med Res Rev 2021;41:709-24.
Trick WE, Scheckler WE, Tokars JI, et al. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2000;119:108-14.
Martin ET, Kaye KS, Knott C, et al. Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2016;37:88-99.
Furui M, Kong PK, Moorthy PSK, et al. Risk factors for sternal wound infection after coronary artery bypass grafting in patients with and without diabetes. Int Heart J 2022;63:426-32.
Balachandran S, Lee A, Denehy L, et al. Risk factors for sternal complications after cardiac operations: a systematic review. Ann Thorac Surg 2016;102:2109-17.
Colombier S, Kessler U, Ferrari E, et al. Influence of deep sternal wound infection on long-term survival after cardiac surgery. Med Sci Monit 2013;19:668-73.
Olsen MA, Lock-Buckley P, Hopkins D, et al. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg 2002;124:136-45.
Bode LGM, Kluytmans JAJW, Wertheim HFL, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362:9-17.
Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2009;73:305-15.
Assadian O, Golling M, Krüger CM, et al. Surgical site infections: guidance for elective surgery during the SARS-CoV-2 pandemic - international recommendations and clinical experience. J Hosp Infect 2021;111:189-99.
Hussain A, Ike DI, Durand-Hill M, Ibrahim S, Roberts N. Sternal wound infections during the COVID-19 pandemic: an unexpected benefit. Asian Cardiovasc Thorac Ann 2021;29:376-80.
Antonello VS, Dallé J, Antonello ICF, et al. Surgical site infection after cesarean delivery in times of COVID-19. Rev Bras Ginecol Obstet 2021;43:374-6.
Perna A, Maruccia F, Gorgoglione FL, et al. Increased frequency of hand hygiene and other infection prevention practices correlates with reduced surgical wound infection rates in spinal surgery during the COVID-19 pandemic. J Clin Med 2022;11:7528.
Sybert M, Oakley CT, Christensen T, et al. Impact of COVID-19 protocols on primary and revision total hip arthroplasty. J Arthroplasty 2022;37:2193-8.
Lazar HL. Commentary: compliance with the American Association for Thoracic Surgery guidelines will prevent sternal wound infections and minimize postoperative complications in cardiac surgery patients during the COVID-19 pandemic. J Thorac Cardiovasc Surg 2020;160:e44-8.
Roshan R, Feroz AS, Rafique Z, Virani N. Rigorous hand hygiene practices among health care workers reduce hospital-associated infections during the COVID-19 pandemic. J Prim Care Community Health 2020;11:2150132720943331.
World Health Organization. Preventing and mitigating COVID-19 at work: policy brief, 19 May 2021. Available from: https://apps.who.int/iris/handle/10665/341328.
Vincent M, Edwards P. Disposable surgical face masks for preventing surgical wound infection in clean surgery. Cochrane Database Syst Rev 2016;4:CD002929.
Ethics Approval
The study protocol was approved by the Audit, Assurance & Effectiveness Team of the University Hospitals of Plymouth (protocol no. CA_2021-22-120 dated 17/09/2021).How to Cite
Bashir, Aladdin, Matthew Holmes, Nebumathew Suresh, Pedram Panahi, Sameh Atta, Hannah T. Perkins, Clinton Lloyd, and Sanjay Asopa. 2023. “The Impact of COVID-19 Prevention Measures on Surgical Wound Infection Rates Post-Cardiac Surgery”. Monaldi Archives for Chest Disease 94 (2). https://doi.org/10.4081/monaldi.2023.2604.
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Sotirios D. Moraitis, Apostolos C. Agrafiotis, Dimitrios Pappas, Chrysovalantis Pothitakis, Maria Stergianni, Ioannis Koukis, Thymic pathology and cardiac myxomas: Coincidence or a closer relationship? , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Concezione Tommasino, Cardiovascular risk assessment in the senior population undergoing anesthesia for non-cardiac surgery , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
- Elio Gorga, Marta Scodro, Francesca Valentini, Renzo D'Ortona, Mariachiara Arisi, Edoardo Sciatti, Ivano Bonadei, Valentina Regazzoni, Enrico Vizzardi, Marco Metra, Piergiacomo Calzavara Pinton, Echocardiographic evaluation of diastolic dysfunction in young and healthy patients with psoriasis: A case-control study , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Francesca Gatta, Yama Haqzad, George Gradinariu, Pietro Giorgio Malvindi, Zubair Khalid, Rona L. Suelo-Calanao, Nader Moawad, Aladdin Bashir, Luke J. Rogers, Clinton Lloyd, Bao Nguyen, Karen Booth, Lu Wang, Nawwar Al-Attar, Neil McDowall, Stuart Watkins, Rana Sayeed, Saleh Baghdadi, Andrea D’Alessio, Maria Monteagudo-vela, Jasmina Djordjevic, Matej Goricar, Solveig Hoppe, Charlotte Bocking, Azar Hussain, Betsy Evans, Salman Arif, Christopher Malkin, Mark Field, Kully Sandhu, Amer Harky, Ahmed Torky, Mauin Uddin, Muhammad Abdulhakeem, Ayman Kenawy, John Massey, Neil Cartwright, Nathan Tyson, Niki Nicou, Kamran Baig, Mark Jones, Firas Aljanadi, Colum G. Owens, Tunde Oyebanji, Joseph Doyle, Mark S. Spence, Paul F. Brennan, Ganesh Manoharan, Taha Ramadan, Sunil Ohri, Mahmoud Loubani, Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis , Monaldi Archives for Chest Disease: Vol. 94 No. 1 (2024)
- Bruno Amato, Mario Santoro, Giuseppe Giugliano, Giuseppe Servillo, Veronica Di Nardo, Lorenza Di Domenico, Rita Compagna, Raffaele Izzo, Outcomes after non-cardiac surgery: Mortality, complications, disability, and rehospitalization , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
- Mahmood Shirzad, Abbasali Karimi, Seyed Hossein Ahmadi, Mehrab Marzban, Mokhtar Tazik, Hermineh Aramin, Predictors and Early Outcome of Prolonged Mechanical Ventilation in Contemporary Heart valve Surgery , Monaldi Archives for Chest Disease: Vol. 74 No. 1 (2010): Cardiac series
- Gian Francesco Mureddu, Current multivariate risk scores in patients undergoing non-cardiac surgery , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
- Rodolfo Citro, Antonello Panza, Paolo Masiello, Amelia Ravera, Lucia Tedesco, Rocco Leone, Marco Mirra, Roberta Giudice, Severino Iesu, Francesco Silvestri, Giuseppe Di Benedetto, Eduardo Bossone, Intramural aortic hematoma: no flap no warning? , Monaldi Archives for Chest Disease: Vol. 76 No. 1 (2011): Cardiac series
- Roberto F.E. Pedretti, Francesco Fattirolli, Raffaele Griffo, Marco Ambrosetti, Elisabetta Angelino, Silvia Brazzo, Ugo Corrà , Nicolò Dasseni, Pompilio Faggiano, Giuseppe Favretto, Oreste Febo, Marina Ferrari, Francesco Giallauria, Cesare Greco, Manuela Iannucci, Maria Teresa La Rovere, Mario Mallardo, Antonio Mazza, Massimo Piepoli, Carmine Riccio, Simonetta Scalvini, Luigi Tavazzi, Pier Luigi Temporelli, Gian Francesco Mureddu, Cardiac Prevention and Rehabilitation “3.0â€: From acute to chronic phase. Position Paper of the ltalian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Francesco Vetta, Gabriella Locorotondo, Giampaolo Vetta, Maria Mignano, Sonia Bracchitta, Prognostic impact of frailty in elderly cardiac surgery patients , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
You may also start an advanced similarity search for this article.
