PURPOSE: Sternal wound infections continue to persist, complicating cardiac surgical procedures and representing significant added hospital costs and are potentially life threatening. Sternal wounds have identical components of that of prosthetic joint replacements; metal, bone and fat. Our orthopedic colleagues have been successful at limiting prosthetic joint infections with the routine use of Pulsed Irrigation with antibiotic solution.
METHODS: Rates of sternal wound infections for this study were recorded for years 2004 consequetively through the 1st quarter of 2007. These rates are also tracked by the New York State Department of Health. The protocol change of using the Stryker InterPulse pulsed suction irrigation system with 3 liter normal saline bags containing 1 million units of Polymyxin and 100,000 units of Bacitracin began 2006. One surgeon's pre and post protocol change was compared for sternal wound infection rates, controlling for differences in surgeons technical variables.
RESULTS: The protocol change in irrigation amounted to a low volume irrigation of the sternal wound prior to closure, with a bulb syringe of 50,000 units of Bacitracin to a high volume irrigation of the wound, utilizing a battery operated hand held pulsed suction irrigator. The high volume irrigant was 3 liters of normal saline containing 1 million units of Polymyxin and 100,000 units of Bacitracin. The 2004 total cases was 259 with 13 infections for a rate of 5%. 2005 was 297 cases with 10 infections for a rate of 3.4%. In 2006, the year of the initiation of the new protocol, there were 268 cases with 5 infections for a rate of 1.9%, statistically significant. For 1st quarter 2007 62 cases with no infections.
CONCLUSION: Pulsed irrigation of the sternal wound prior to closure with high volume antibiotic irrigation containing Polymyxin and Bacitracin may be valuable in decreasing the incidence of sternal wound infections.
CLINICAL IMPLICATIONS: The routine use of pulsed irrigation of antibiotic solutions after joint replacements may be advisable for sternal wounds, given the similarities of the components including metal, bone and fat.
DISCLOSURE: Alan Hartman, No Financial Disclosure Information; No Product/Research Disclosure Information