ALISO VIEJO, Calif. - June 3, 2025 – A nurse-led initiative at a Denver hospital led to fewer complications for female patients recovering from open-heart surgery and decreased the wound incidence rate following sternotomies from 6.4% to 0.0%, according to a study published in Critical Care Nurse (CCN).
“The Bra Project: Preventing Wounds in Women After Sternotomy” details how the cardiac surgery nurses at Saint Joseph Hospital, part of Intermountain Health in Denver, modeled their initiative on existing research and evidence, leading to the selection of a new surgical bra, an updated process to improve fit, and patient education.
Primary author Lauren Zobec, BSN, RN, PCCN, is a cardiac step-down nurse serving as a charge nurse at Saint Joseph. Co-author Cecile B. Evans, PhD, RN, is a nursing professional development specialist at another Intermountain Health facility, St. Mary’s Regional Hospital, Grand Junction, Colorado.
“Nurses spend the most time with our patients, which provides us with additional insight on the issues that often contribute to complications,” Zobec said. “By paying close attention to our patients and listening to their concerns, we discovered a pattern that was confirmed by the data. We take pride in our patient outcomes and quality of care while always seeking opportunities to improve.”
The initiative was a response to the nurses noticing a trend in patients who developed poststernotomy wounds: Readmissions due to wounds seemed to be exclusive to women with large breasts. Anecdotal reports from patients mentioned that the bra was uncomfortable and often didn’t fit well, leading to lack of use or pressure injuries from constriction.
Saint Joseph Hospital has a premier cardiac surgery program with a mean of 370 open-heart surgical procedures per year.
After open-heart surgery, patients are required to wear a surgical bra nearly 24 hours a day for several weeks while the incision heals. Prior to the initiative, women were placed in a surgical bra without formal fitting while still in the operating room, a process the hospital hadn’t updated in over a decade.
Over a 12-month period, seven of 110 female patients who underwent sternotomy required 274 additional hospital days related to pressure injuries and sternal dehiscence after sternotomy. The hospital’s financial burden for these longer stays was more than $751,000.
After reviewing various breast-support products, nurses selected a new bra that reduced wound tension, had stretchable material that could expand for swelling, did not absorb moisture, and was available in a range of sizes to accommodate all women. The product was comparable in cost and readily available in the United States to minimize supply chain concerns. It also featured a hook-and-loop front closure that allowed for quicker sternal access during emergency resuscitation.
All hospital staff members affected by the change were introduced to the new bra in person, providing them an opportunity to touch the fabric and learn more about its details. Inpatient and outpatient staff members caring for sternotomy patients received tape measures and written sizing guides.
A newly developed checklist was placed with each patient’s paper medical record that included recent vital signs, blood glucose levels, height, weight and a chart with chest circumference and associated bra size.
As part of the new protocol, staff members measured patients’ chest circumference before surgery to ensure a more accurate fit and dressed patients in the bra in the operating room immediately after surgery.
The new bra was used for 82 patients over a 12-month period, and none of the patients who wore the bra developed sternal dehiscence or chest pressure wounds. Anecdotal reports included compliments about the fabric and the fit, with some patients requesting an additional bra upon discharge to provide uninterrupted use at home while one bra was being laundered.
As AACN’s bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.
About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of about 130,000 and can be accessed at http://ccn.aacnjournals.org/.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.
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