ERAS® Cardiac Society Turnkey Order Set for Surgical Site Infection Prevention: Proceedings from the AATS ERAS Conclave 2023
Author Department
Surgery
Document Type
Article, Peer-reviewed
Publication Date
4-2024
Abstract
Objectives: Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality, consume healthcare resources, impair recovery, and diminish patients' quality of life. Numerous guidelines and expert consensus documents have been published to address the prevention and management of SSIs. Our objective is to integrate these documents into an order set that will facilitate the adoption and implementation of evidence-based best practices for preventing and managing SSIs following cardiac surgery.
Methods: Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set (TKO) for SSI reduction. Orders derived from consistent Class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the TKO in bold type. Selected orders that were inconsistent Class I or IIA, Class IIB or otherwise supported by published evidence, were also included in italicized type.
Results: Preventative care begins with the preoperative identification of both modifiable and non-modifiable SSI risks by healthcare providers. Assessment tools can be utilized to assist in identifying patients at a high risk of SSI. Preoperative recommendations include screening for and treating Staphylococcus aureus nasal carriage. Intraoperatively, tailored prophylactic intravenous antibiotics and maintaining blood glucose levels below 180 mg/dL are essential elements. Postoperative care includes maintaining normothermia, glucose control and patient engagement.
Conclusion: Despite the well-documented advantages of a multidisciplinary care pathway for SSI in cardiac surgery, there are inconsistencies in its adoption and implementation. This manuscript provides an order set that incorporates recommendations from existing guidelines to prevent SSI in the cardiac surgical population.
Keywords: Cardiac Surgery; Critical Care; ERAS; Enhanced Recovery After Surgery; Perioperative Care; Postoperative Surgical Site Infection; Surgical Site Infection.
Recommended Citation
Crisafi C, Grant MC, Rea A, Morton-Bailey V, Gregory AJ, Arora RC, Chatterjee S, Lother SA, Cangut B, Engelman DT; ERAS Cardiac Working Group. ERAS® Cardiac Society Turnkey Order Set for Surgical Site Infection Prevention: Proceedings from the AATS ERAS Conclave 2023. J Thorac Cardiovasc Surg. 2024 Apr 2:S0022-5223(24)00281-2. doi: 10.1016/j.jtcvs.2024.03.027. Epub ahead of print.
PMID
38574802