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Protocol reduces sternal wound infections in children by 61 percent

A two-year effort to prevent infections in children healing from cardiac surgery reduced sternum infections by 61 percent, a San Antonio researcher announced at the Cardiology 2012 conference Feb. 23 in Orlando, Fla.

Faculty from UT Medicine San Antonio carried out a new infection-control protocol for 308 children who underwent sternotomies at CHRISTUS Santa Rosa Children's Hospital between 2009 and 2011. UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio.

Approach to children not standardized

A sternotomy is a surgical incision through the sternum. This particular study was the follow-up to an initial nationwide, multi-institutional study carried out by the group in 2009. The first study revealed that programs across the country had no standardized manner in which to prevent sternal wound infections (Annals of Thoracic Surgery 2011; 91:799-804). "This was noted to be of concern, as the adult cardiac surgical population has well-described protocols to prevent such infections," said S. Adil Husain, M.D., of UT Medicine San Antonio. He is associate professor of cardiothoracic surgery in the School of Medicine.

Multiple interventions implemented

The protocol tested in the follow-up study included preoperative baths with a skin disinfectant, the use of disposable, single-use electrodes, and administration of antibiotics no longer than an hour before the start of surgery. The number of sternal wound infections decreased from 14 the first year of the study to five the second year.

The sternum, also called the breastbone, anchors the rib cage protecting the heart and lungs. To correct congenital heart defects, surgeons in many cases must break open the sternum to gain access to the operation site. More than 350 pediatric cardiac surgical cases are performed annually at the children's hospital with the sternum being opened at least 75 percent of the time.

Deep infections may involve areas around heart

"Sternal wound infection is relatively infrequent; however, when it occurs it increases the child's length of stay and recovery time," said Cathy Woodward, D.N.P., RN, PNP-AC, of UT Medicine and assistant professor of pediatrics in the School of Medicine. "The bone, muscle and tissue around the heart can become involved when the infection is deep."

Dr. Woodward presented the clinical findings in Orlando. The team also included Dr. Husain and critical care specialists Minnette Son, M.D., professor of pediatrics, and Richard Taylor, M.D., associate professor of pediatrics.

Multicenter study would be logical next step

Children from newborns to age 18 were included in the study. Using a protocol for children with delayed closure of the sternum also produced a lower infection rate, although it was not statistically significant.

"Because we had so few infections, we don't have enough statistical power to analyze these results," Dr. Woodward said. "This pilot finding lends itself to the need to do a multicenter study."

On the Web and Twitter

For current news from the UT Health Science Center San Antonio, please visit our news release website or follow us on Twitter @uthscsa.

About UT Medicine San Antonio

UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center at San Antonio. With more than 700 doctors – all faculty from the School of Medicine – UT Medicine is the largest medical practice in Central and South Texas, with expertise in more than 60 different branches of medicine. Primary care doctors and specialists see patients in private practice at UT Medicine's clinical home, the Medical Arts & Research Center (MARC), located in the South Texas Medical Center at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and there are clinics and physicians at several local and regional hospitals, including CHRISTUS Santa Rosa, University Hospital and Baptist Medical Center. Call 210-450-9000 to schedule an appointment, or visit the Web site at for a complete listing of clinics and phone numbers.

About CHRISTUS Santa Rosa Health System

Founded in 1869 by the Sisters of Charity of the Incarnate Word of Houston and San Antonio, CHRISTUS Santa Rosa is a Catholic, faith-based, nonprofit health and wellness ministry dedicated to extending the healing ministry of Jesus Christ and providing the highest quality medical care and services available. As one of the top health care organizations in South-Central Texas, CHRISTUS Santa Rosa has five hospital campuses, with campuses located in downtown San Antonio, in the South Texas Medical Center, in New Braunfels, in Westover Hills, and a short-stay surgical hospital in Alamo Heights. CHRISTUS Santa Rosa Children's Hospital, located at the downtown campus, is San Antonio's first children's hospital. The Children's Hospital is an academic teaching facility affiliated with The University of Texas Health Science Center at San Antonio. CHRISTUS Santa Rosa Health System also owns a majority interest in CHRISTUS Santa Rosa Physicians Ambulatory Surgery Centers – San Antonio, LLC, a joint venture physician partnership which is comprised of three outpatient surgery centers in San Antonio with facilities in Alamo Heights, Stone Oak, and the Medical Center. Additionally, CHRISTUS Santa Rosa Health System owns a majority interest in the CHRISTUS Santa Rosa Physicians Ambulatory Surgery Center in New Braunfels, a joint venture physician partnership. CHRISTUS Santa Rosa is the preferred health system of the San Antonio SPURS. For additional information on CHRISTUS Santa Rosa, visit Find us on Facebook at and follow us on Twitter at

Will Sansom | EurekAlert!
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