The Coronary artery bypass graft (CABG) procedure is commonly used among patients with cardiovascular disease (Lorenz, Lorenz, & Codd, 2005). However, depending on the individual characteristics of patients undergoing this procedure and other hospital, surgical and physician-related factors, a number of adverse complications may develop and produce negative effects on patient outcomes. Hospital-acquired infections (HAIs), particularly surgical site infections (SSIs), may contribute significantly to patient outcomes.
HAIs, also called nosocomial infections, are infections that are acquired by patients in the hospital setting from anywhere around 48 hours of admission (CDC, 2007). These infections are not directly related to the original condition for which the patient reported but HAIs come about as a result of a procedure or treatment utilized in their diagnosis or treatment (Rizzo & Odle, 2006). Hospital acquired infections are the leading cause of complications in patients that are hospitalized (Mohr, Peninger, & Ostrosky-Zeichner, 2005). In patients undergoing CABG a number of cardiovascular complications may also impact patient outcomes.
Such complications include mortality, usually within 30 days of the procedure; patients may experience strokes, myocardial infarctions, pneumonia, reintubation, renal failure, extended hospital stay and similar complications (Yap, Mohajeri, & Yii, 2007). Additionally individual patient characteristics may put CABG patients at a heightened risk of developing these infections or complications during and/or after surgery. Patients with diabetes have been shown to have poorer outcomes than other patients with respect to a multiplicity of surgical procedures, including CABG (Lorenz et al.
, 2005). Within the hospital setting it is important that proper procedures and practices are followed in order to minimize the negative outcomes of surgical procedures. The United States government, through its Center for Disease Control and Prevention (See www. cdc. gov), has continuously emphasized the need to ensure patient safety by adopting strict, evidence-based practices, to ensure that complications are minimized and that patients receive the optimal level of care possible for their condition.
Researchers have revealed that hyperglycemia negatively affects patient outcomes by increasing mortality and morbidity. Research has also shown that patients with diabetes are at an increased risk of developing complications and thus may have poorer outcomes than their non-diabetic counterparts (Lorenz et al. , 2005). Pennel, Smith-Snyder, Hudson, Hamar and Westerfield (2005) suggested that strict glycemic control, as a mechanism to monitor hyperglycemia, was effective in improving mortality and morbidity outcomes in patients undergoing CABG surgery.
Hospitals should be interested in how patient outcomes are monitored in their individual settings and seek to improve practices that do not meet minimum standards, leading eventually to improved patient outcomes. Though statistics may exist at a national level describing critical care nurses’ adherence to prescribed practice guidelines on best techniques to diminish the possible negative outcomes in patients undergoing CABG surgery, it is important to understand the true nature of these practices at the individual hospital level so that necessary programs can be employed to improve deficient areas.
Most importantly hospitals need to understand how individual patient characteristics, particularly the presence of diabetes, hospital acquired infections and surgical complications affect patient outcomes and how these factors vary between patients who have diabetes and those who do not.