Sternal Wound Action Team (S.W.A.T.)

Project Topic:

Decreasing sternal wound infections (SWIs)

Hospital Unit:

• Cardiothoracic Intensive Care Unit (CTICU)
• 5 Garden North (Cardiothoracic Surgery Stepdown)

CSI Participants:

• Alexandra Taylor Berger, BSN, RN, PCCN
• Kayla Dunn, MSN, RN, PCCN
• Mike Spicer, MS, AGNP, RN, CCRN-CSC
• Tilu Chacko, BSN, RN, CCRN

Project Goals/Objectives:

1. Decrease incidence of SWIs 40% through an interdisciplinary approach
2. Create a bundled approach to SWI prevention that is unit-specific
3. Create an auditing tool to measure compliance with new bundle
4. Educate 90% of staff members on ongoing changes
5. Conduct periodic dosing to reinforce bundle compliance

Project Outcomes:

1. Decreased the incidence of SWIs 54.5%
2. Created a nurse-driven SWI prevention bundle
3. Educated 95% of staff members on use of the SWI bundle
4. Achieved hospital-wide involvement and engagement, with nine different units actively participating
5. Established strong relationships between teammates
6. These outcomes resulted in a positive estimated annual fiscal impact of $384,411.

Project Overview:

Baseline data for our hospital revealed that our sternal wound infection (SWI) rate was above the Standardized Infection Ratio (SIR) of 1%. This was a significant issue, as a SIR above 1% means that the Centers for Medicaid and Medicare Services (CMS) will not provide reimbursement if a patient is readmitted for a SWI. The high incidence of SWIs prompted our CSI team to act.

We decided to develop a nurse-driven bundle to help guide nurses in preventing SWIs through an evidence-based, systematic and comprehensive approach. At the beginning of this project, there was no standardized nursing protocol for SWI prevention at our hospital — it was based on surgeon preference and varied greatly. Our CSI team developed the new bundle in consultation with the cardiothoracic (CT) surgeons and medical directors in the Cardiac Division.

We introduced our project and the SWI prevention bundle to the Cardiothoracic ICU and 5 Garden North unit (Cardiothoracic Stepdown) through an educational kickoff event featuring badge reels (“badge buddies”) and Starbucks gift cards. Our CSI team conducted staff education was via unit-specific and hospital-wide meetings, new hire onboarding, and team huddles.

In addition to the badge buddies and gift cards, we posted information sheets were on staff computers throughout the units, and provided staff with a mannequin to observe and practice dressing changes in a safe and controlled environment. These simple reminders assisted in gaining adherence to the new nursing bundle. Our strategy included development of a bundle compliance tracking tool to identify target areas for education redosing. We also updated and shared compliance metrics with our CT surgeons and staff at monthly Cardiac Outcomes meetings.

Over time, interest in our project and the bundle grew, as did enthusiasm about the decreasing SWI rate. We started hosting monthly educational meetings throughout several units. This gave the CSI team multiple opportunities to re-dose with breakfast events, additional badge reels and canvas swag bags. These educational in-services were conducted for the NewYork-Presbyterian Inpatient Cardiac Division, Perioperative areas, Interventional Radiology and Staff Advisory Council as well as at our hospital’s Quality Skills Day and Magnet Kickoff Day.

Our efforts resulted in decreasing SWI rates 54.5%. Collaboration between the CSI and Cardiothoracic Surgical teams was instrumental in achieving this goal —the success of our project was a result of the collective effort and dedication of all involved. The positive outcome of our project has sparked discussions about the continuation of the bundle intervention.