Reducing Sternal Site Surgical Site Infections by Postdischarge Follow-Up Using WhatsApp

Abstract

Background: We conduct ∼180–200 CABG surgeries a year, and >70% of these patients are diabetic. Our SSI rate for sternal site was 4.4%, above the global benchmarks, and on review of the risk factors, poor glycemic control was identified as a major risk factor. Despite focusing on and achieving excellent glycemic control in the perioperative period, the SSI rates did not decrease significantly. We identified that the predischarge insulin regimens were inadequate for the patient once they returned to meals at home. Hence, we extended the interventions to the postdischarge phase and observed the impact of this change on SSIs. Methods: We developed a multidisciplinary and cross-functional team of cardiac surgeons, endocrinologists, physician assistants, infection control nurses and quality professionals. The CABG admissions information was obtained when financial clearance was sought for the procedure; the quality improvement professionals tracked these patients to ensure involvement of the endocrinology team. The physician assistant conducted the education to the patient and family regarding sugar management and use of a glucometer at home. The quality improvement team took a weekly report from the physician assistant and from the patient regarding the frequency of interactions and achievement of glycemic control. At the time of discharge, each of the diabetic patients who underwent CABG were educated by the physician assistant in the use of a glucometer, were provided with a sugar monitoring and insulin dosing chart as well as a WhatsApp number. The patient’s were instructed to monitor the sugars at specified intervals, to input the data into the personalized chart, and to send it to the PA through WhatsApp. The physician assistant then provided instructions on the insulin dosages using a standing order (dynamic insulin prescription regimen) developed by the endocrinologist. Results: The sternal site infection rate among the CABG patients dropped from 4.44% (4 cases of 90 surgeries) to 1.78% (2 cases of 112 patients), a 60% improvement. Readmissions among the CABG patients dropped from 3 cases in the study period to zero during the project phase. Conclusion: We have achieved significant reduction in sternal site SSI by (1) implementing a novel strategy of focusing on the postdischarge period and home management of blood sugar; (2) using freely available technology, WhatsApp; and (3) effectively using physician assistants by training and developing standing order sets for insulin.

Funding: None

Disclosures: None