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J Hosp Infect. 2011 Apr;77(4):348-51. doi: 10.1016/j.jhin.2010.12.005. Epub 2011 Feb 18.

Pre-educational intervention survey of healthcare practitioners' compliance with infection prevention measures in cardiothoracic surgery: low compliance but internationally comparable surgical site infection rate.

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Mater Dei Hospital, Msida, Malta.


Surgical site infections (SSIs) are challenging problems leading to significant postoperative morbidity and mortality and may reflect the level of adherence to infection control policies. We used a structured observational method to collect data about infection control practices among surgeons, anaesthetists, nurses, cardiopulmonary bypass technicians and orderlies practising in the cardiac operating theatre during open heart surgery at Mater Dei Hospital. To prevent bias, we did not disclose the actual procedures observed to the surgical team members, but participants knew they were being observed for infection control practices. We measured the 30-day SSI rate by post-discharge telephonic surveillance among surviving open heart surgery patients who had consented to the survey. We observed practices during 30 randomly chosen operations and found higher levels of inadequate practices related to environmental disinfection, hand hygiene, operating room traffic and surgical attire of non-scrubbed personnel (anaesthesiologists and cardiopulmonary bypass technicians). In all, 140 of 155 patients who underwent open heart surgery were followed up, achieving a response rate of 91.5%. Superficial and deep SSI rates were 16.4% and 4.3% respectively, including both sternal and harvest site infections. We found poor compliance with infection control practices by non-scrubbed personnel involved in cardiac surgery and observed a high surgical site infection rate, the majority being leg wound infections following saphenous vein harvesting.

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