| Recognizing Mediastinitis |
| Nanette Lavoie-Vaughan, M.S.N., APN |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
References
1. Dacey MJ. Mediastinitis. eMedicine website. Available at:
www.emedicine.com/med/topic2798.htm. Accessed April 6, 2005.
2. Carey MJ. Mediastinitis. eMedicine website. Available at:
www.emedicine.com/emerg/topic307.htm. Accessed April 6, 2005.
3. King R and Barnes A. Mediastinitis. Curr Treatment Options Infect Dis.
2003;5:377-386.
4. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and
management. Ann Thorac Surg. 1996;61(3):1030-1036.
5. Thomas S. An introduction to the use of vacuum assisted closure.
Available at:
http://www.worldwidewounds.com/2001/may/Thomas/Vacuum-Assisted-Clo
sure.html. Accessed April 6, 2005.
6. Swearingin P, Keen J. Manual of Critical Care Nursing: Nursing
Interventions and Collaborative Management. 4th ed. St. Louis, MO:
Mosby; 2001.
1. Dacey MJ. Mediastinitis. eMedicine website. Available at:
www.emedicine.com/med/topic2798.htm. Accessed April 6, 2005.
2. Carey MJ. Mediastinitis. eMedicine website. Available at:
www.emedicine.com/emerg/topic307.htm. Accessed April 6, 2005.
3. King R and Barnes A. Mediastinitis. Curr Treatment Options Infect Dis.
2003;5:377-386.
4. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and
management. Ann Thorac Surg. 1996;61(3):1030-1036.
5. Thomas S. An introduction to the use of vacuum assisted closure.
Available at:
http://www.worldwidewounds.com/2001/may/Thomas/Vacuum-Assisted-Clo
sure.html. Accessed April 6, 2005.
6. Swearingin P, Keen J. Manual of Critical Care Nursing: Nursing
Interventions and Collaborative Management. 4th ed. St. Louis, MO:
Mosby; 2001.
Infection Control Intervention for Cardiac Patients
Nalini Rao has developed a clinical process model for infection control
intervention in cardiac surgery patients. It’s based on a seven-part
intervention program.
Step 1: Prospective surveillance of superficial and deep chest
infections. By identifying patients with clinical risk factors (such as diabetes,
immune deficiency, malnutrition, hepatic dysfunction, alcohol or drug abuse,
COPD, and obesity), measures to prevent postoperative infection can be
implemented.
Step 2: Post-discharge follow-up of patients readmitted within 30 days
with any wound-related complications.
Step 3: Use of chlorhexidine showers the night before surgery and the
morning of surgery.
Step 4: Do not shave the site. Clip only the hair necessary for
operative preparation the morning of surgery.
Step 5: Administer prophylactic antibiotics before and during surgery in
patients at high risk.
Step 6: Segregate surgical instruments between the graft harvest site
and the chest cavity.
Step 7 Implement preoperative, individualized insulin protocol for
diabetic patients before surgery.
Source: Rao N, Schilling D, Rice J, Ridenhour M, Mook W, Santa E.
Prevention of postoperative mediastinitis: a clinical process improvement
model. J Healthc Qual. 2004;26(1):22-7.
Nalini Rao has developed a clinical process model for infection control
intervention in cardiac surgery patients. It’s based on a seven-part
intervention program.
Step 1: Prospective surveillance of superficial and deep chest
infections. By identifying patients with clinical risk factors (such as diabetes,
immune deficiency, malnutrition, hepatic dysfunction, alcohol or drug abuse,
COPD, and obesity), measures to prevent postoperative infection can be
implemented.
Step 2: Post-discharge follow-up of patients readmitted within 30 days
with any wound-related complications.
Step 3: Use of chlorhexidine showers the night before surgery and the
morning of surgery.
Step 4: Do not shave the site. Clip only the hair necessary for
operative preparation the morning of surgery.
Step 5: Administer prophylactic antibiotics before and during surgery in
patients at high risk.
Step 6: Segregate surgical instruments between the graft harvest site
and the chest cavity.
Step 7 Implement preoperative, individualized insulin protocol for
diabetic patients before surgery.
Source: Rao N, Schilling D, Rice J, Ridenhour M, Mook W, Santa E.
Prevention of postoperative mediastinitis: a clinical process improvement
model. J Healthc Qual. 2004;26(1):22-7.
Acute Mediastinitis
Type 1: Two weeks postoperative, no risk factors
Type 2: Two to six weeks postoperative, no risk factors
Type 3: Type 1 or Type 2 with risk factors
Type 4: Type 1, 2, or 3, after at least one course of
therapy
Type 5: Initially appears six weeks after surgery
Source: El Oakley RM, Wright JE. Postoperative mediastinitis: classification
and management. Surg. 1996;6(3):1030.
Type 1: Two weeks postoperative, no risk factors
Type 2: Two to six weeks postoperative, no risk factors
Type 3: Type 1 or Type 2 with risk factors
Type 4: Type 1, 2, or 3, after at least one course of
therapy
Type 5: Initially appears six weeks after surgery
Source: El Oakley RM, Wright JE. Postoperative mediastinitis: classification
and management. Surg. 1996;6(3):1030.