Multicenter Infection Surveillance Study Following Open Heart Surgery

• hospital acquired pneumonia [ Time Frame: 30 days postoperative ] [ Designated as safety issue: Yes ]
  

• surgical site infection [ Time Frame: 30 days postoperative ] [ Designated as safety issue: Yes ]
  
• hospital length of stay [ Time Frame: primary admission ] [ Designated as safety issue: No ]
  

Nosocomial infections are recognized as an important cause of increased patient mor-bidity and mortality. The reported prevalence for nosocomial infections most com-monly ranges from 5 to 20%, but can be significantly greater among patients requiring intensive care. The most common sites of hospital-acquired infection include the lung, urinary tract, surgical wounds, and the bloodstream. Patients undergoing cardiac surgery appear to be at increased risk for the develop-ment of nosocomial infections due to the presence of multiple surgical wounds (chest and lower extremity incisions), frequent postoperative utilization of invasive devices (i.e. central venous catheters, chest drains, intra-aortic balloon counter pulsation, pulmonary artery catheter), and the common use of prophylactic or empiric antibiot-ics in the perioperative period. In the cardiac surgical postoperative period, nosocomial infections have been found to be associated with prolonged length of stay (LOS) in the ICU and total hospitaliza-tion, development of multiorgan dysfunction, and increased hospital mortality. Nosocomial Pneumonia (NP) is in fact the leading cause of mortality due to hospital-acquired infec-tions.22 Patients with VAP have been found in various studies to have significantly higher mortality rates than those without VAP, with ranges of 20.2-45.5% and 8.5-32.2%, respectively. Strategies that both reduce postoperative pain and sedation have the potential to reduce postoperative pneumonia by allowing earlier extubation and more effective pulmonary toilet post-extubation. Non-opioid pain management has the potential to reduce NP rates because of superior pain management, as well as the reduction in opioids required, and the concomitant avoidance of opioid side effects. The clinical and financial consequences of NP justify aggressively pursuing strategies aimed at prevention. Specifically, these strategies are targeted at reducing the incidence of NP by addressing the modifiable risk factors including prolonged endotracheal intubation and ventilator support, sedation, and long hospital LOS.