Peri-Operative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery as a Surgical Site Infection Prevention Strategy

ISSUE: Tight control of blood glucose levels in the peri-operative period appears to lead to fewer surgical site infections (SSI) in diabetic and non-diabetic patients. Individuals undergoing coronary artery bypass grafting (CABG) at Greenville Memorial Hospital (GMH) were found to have poor glucose control (6.7 percent of baseline had all glucose levels of less than 200 during the 48 hours postoperatively). The actions taken to improve glucose control are described. PROJECT: A multidisciplinary team was formed to improve practices that reduce the risk of SSI including glucose control. The cardiovascular surgery postoperative insulin protocol was modified and an intra-operative insulin drip protocol developed. A method to monitor blood sugars in the operating room was implemented. Due to concerns about the potential development of hypoglycemia, blood glucose targets were gradually reduced from the initial 140-180 down to 110–140 with plans of an eventual target of 80–120. Glucose levels were monitored intra-operatively and for 48 hours postoperatively for all patients undergoing CABG. RESULTS: The percentage of patients undergoing CABG with glucose levels maintained at less than 200 for 2 days postoperatively has improved from 6.7% to as high as 80%. This reflects a 92% improvement. The CABG SSI rate has declined during this period from 4.0 % to 2.0% and reflects a statistically significant downward trend. LESSONS LEARNED: Glucose control procedure change requires multidisciplinary collaboration. A slower approach to improving glucose control was needed to obtain buy-in from clinicians.