More than 400,000 coronary artery bypass grafting (CABG) procedures are performed every year in the United States (U.S.). Patients undergoing CABG surgery are at risk for a number of adverse sequelae, many of which impact survival and contribute to overall health-care costs. Healthcare-acquired infections (HAIs), including pneumonia and superficial and deep sternal wound infections, occur among 16% of CABG patients and elevate a patient's risk of mortality and add excess upfront and long-term expenditures to the health care system. A number of barriers prevent wide-scale improvements in HAI rates within the setting of CABG surgery. While a number of HAI prophylaxis measures have been developed, these measures do not fully encompass the set of practices that may impact a patient's risk of HAI. Identifying cardiac surgery specific risk factors would serve as th foundation for targeted quality improvement strategies. In the absence of definitive data concerning best practices, HAI prophylaxis is variable across surgeons and institutions, resulting in unnecessary morbidity and cost. Prior work has shown the value of implementing evidence-based protocols in the general intensive care unit setting. To what extent the implementation of cardiac surgery specific standardized practices results in lower HAI rates is uncertain. An understanding of the effectiveness of this approach would certainly assist surgeons and institutions in providing safer care to their patient populations. Rates of HAIs vary from 0-26% across the 33 institutions performing CABG surgery in Michigan. This application seeks to reduce this rate by identifying and subsequently implementing standardized practices, and evaluating their impact on HAI rates. This study will be based on the prospective data and regional quality improvement activities and infrastructure of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC). We will evaluate the effectiveness of these standardized practices in reducing HAIs regionally and relative to national rates during the same time period.

Public Health Relevance

Healthcare-acquired infections (HAIs), while potentially avoidable, are major contributors to morbidity and mortality in the setting of cardiac surgery. In the absence of well-grounded evidence regarding prophylaxis, practices and outcomes vary. The goal of this project is to reduce HAIs among Michigan hospitals, with the overarching goal of improving the quality and safety of care.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Special Emphasis Panel (HSQR)
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Gray, Darryl T
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Shih, Terry; Zhang, Min; Kommareddi, Mallika et al. (2014) Center-level variation in infection rates after coronary artery bypass grafting. Circ Cardiovasc Qual Outcomes 7:567-73