Infection Prevention Strategies in Pediatric Cardiac Surgery: Midline Incision Sites
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Authors
Carollo, Madison
Issue Date
2025-12-04
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Abstract
Background: Congenital heart defects affect approximately 1% of births per year (CDC, 2024). About 1 in 4 infants born with a heart defect will need procedures or surgery in their first year of life (CDC, 2024). These procedures include open-heart surgery via median sternotomy. Surgical Site Infections (SSIs) account for approximately 0.25-6% of Hospital-Acquired Infections (HAIs). SSIs are associated with a mortality rate between 7 to 20% and increased hospital costs. Infection Prevention Bundles have been implemented in many pediatric institutions to reduce the incidence of surgical site infections (SSIs). Some institutions report an increase in early detection of sternal wound infections through structured surveillance. This study aims to implement structured incisional rounding on a biweekly basis.
Setting: This project was conducted in a 24-bed Cardiac Intensive Care Unit (CICU) at the Heart Center of a Midwest tertiary pediatric referral hospital. All pediatric patients undergoing cardiac surgery via midline sternotomy and admitted to the CICU were eligible for inclusion and were followed until discharge or resolution of incision-related complications.
Methods: A multidisciplinary quality improvement team initiative involving the implementation of structured incisional rounding twice weekly, beginning in July of 2025. Advanced Practice Providers (APPs) conducted visual assessments of surgical sites, documented findings in real time and escalated concerns as needed. Data, including assessment findings, time-to-intervention, and SSI incidence, were collected in a centralized Excel spreadsheet and compared with pre-implementation baseline rates.
Results A total of 7 patients developed incision-related complications during the study period. No patients met the criteria for incisional infection. Complications arose on average at postop day 7. Most complications improved following early recognition and intervention within 1.1 days.
Conclusion: Structured incisional rounding may enhance early identification and management of postoperative wound complications in pediatric patients undergoing cardiac surgery. This quality improvement initiative has the potential to reduce SSIs, but further research is necessary.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University