Priority 10 from the Heart Surgery PSP

UNCERTAINTY: How do we reduce and manage infections after heart surgery including surgical site/sternal wound infection and pneumonia? (JLA PSP Priority 10)
Overall ranking	10
JLA question ID	0088/10
Explanatory note	The incidence of surgical site infections (SSI) in UK cardiac surgery centres was 3.8% following coronary artery bypass grafts (CABG) and 1.7% in non-CABG operations. This is associated with a 10-fold increase in mortality, a six-fold increase in the risk of readmission to hospital. Likewise, pulmonary complications such as lower respiratory tract infection can lead to prolonged ICU and hospital stay and result in a six-fold increase in mortality. The Cardiothoracic Interdisciplinary Research Network has recently completed a Cochrane systematic review of trials of interventions to prevent or reduce SSI in cardiac surgery. Identified evidence gaps related to choice of preoperative skin antiseptic, antibiotic prophylaxis duration and choice, dexamethasone effect on wound healing, dressing removal time, and benefits of microbial sealants. Evidence on the prevention of post-surgery lower respiratory tract infection has developed in largely non-cardiac surgical settings. ~ How can we reduce the likelihood of post-surgery infections including surgical site infection and respiratory tract infection? What is the best management for sternal wound infections?
Evidence	Dumville JC, McFarlane E, Edwards P, Lipp A, Holmes A, Liu Z. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database of Systematic Reviews. 2015(4).; Liu Z, Dumville JC, Norman G, Westby MJ, Blazeby J, McFarlane E, et al. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2018(2); (NICE) NIfHaCE. Surgical site infections: prevention and treatment : guidance (CG74). 2008.
Health Research Classification System category	Cardiovascular

Extra information provided by this PSP
Original uncertainty examples	How surgical site infection being prevented on all cardiac surgery? ~ How can we reduce the likelihood of post-surgery infection (e.g. pneumonia)? ~ What is the best management for sternal wound infection?
Submitted by	2 x patient, 2 x carer, 17 x healthcare professional, 1 others

PSP information
PSP unique ID	0088
PSP name	Heart Surgery
Total number of uncertainties identified by this PSP.	45 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	11 July 2019