Nursing Care for Prevention of Sternal Wound Infection in Patients after Coronary Artery Bypass Graft Surgery

Main Article Content

Pinyo Jaroensuk
Noraluk Ua-Kit
Sirinapha Jittimanee


Sternal wound infection in patients after coronary artery bypass graft (CABG)surgery is an important complication that affects physical and psychological dimensions.The physical dimension may include wound pain, isolation, delayed wound healing,wound dehiscence, re-operation, and prolonged length of stay; the psychological dimension may include hopeless, depression, and feeling of insecurity. From this literature review, factors related to sternal wound infection among patients after CABG surgery are as follows: 1) the host (e.g., age, gender, obesity, malnutrition, anemia,
comorbidities, level of hemoglobin A1 C, estimated glomerular filtration rate, and left ventricular ejection fraction, and attitude toward surgical wound care), 2) the agent(e.g., pathogen), and 3) the environment (e.g., types of surgery and duration time of surgical site infection). This article aims to describe factors related to sternal wound infection, nursing care for preventing sternal wound infection, and patient self-care at home, leading to prevention of sternal wound infection, patient safety, and increased quality of life.
Keywords : Coronary artery bypass graft surgery, Nursing care, Prevention, Sternal wound infection

Article Details

How to Cite
Jaroensuk P, Ua-Kit N, Jittimanee S. Nursing Care for Prevention of Sternal Wound Infection in Patients after Coronary Artery Bypass Graft Surgery. Nurs Res Inno J [Internet]. 2024 Apr. 19 [cited 2024 Jul. 25];30(1). Available from:
Academic Articles


Opas Satdhabudha. Essentials of heart surgery. Pathum Thani: Thammasat Printing House; 2018. (in Thai)

GattiG,FioreA, CeschiaA, EcarnotF, ChaaraR, Luzzati R,etal.Risk stratification tool for all surgical site infections after coronary artery bypass grafting. Infect Control Hosp Epidemiol. 2021;42(2):182-93. doi: 10.1017/ice.2020.412. Epub 2020 Sep 3.PMID: 32880242.

Gulack BC, Kirkwood KA,ShiW,SmithPK, Alexander JH, Burks SG, et al. Secondary surgical-site infection after coronary artery bypass grafting: a multi-institutional prospective cohort study.J Thorac Cardiovasc Surg. 2018;155(4):1555-62.e1. doi: 10.1016/j.jtcvs. 2017.

078. Epub 2017 Dec 6.

Lalin C, Atiya S. Complications and health behaviors among persons undergone coronary artery bypass grafting(CABG). The Southern College Network Journal of Nursing and Public Health. 2019;6(1):246-59.(in Thai)

Locke T,ParsonsH,BriffaN,StottM,deSilva TI,Darton TC. A bundle of infection control measures reduces postoperative sternal wound infection due to Staphylococcus aureus but not gram-negative bacteria: a retrospective analysis of 6903 patient episodes. J Hosp Infect.2022;126:21-8.doi: 10.1016/j.jhin.2022.03.006.Epub 2022 Mar 24.PMID: 35341810.

Uthumporn S, A-dhus J, Apastra S, Nathaporn C, Tanaset K, HutthyaS. A development of guidelines for prevention of surgical site infection after cardiac surgery. Journal of Vongchavalitkul University.2019;32(2):30-9.(inThai)

Chonnamet Techasaensiri. SSI Bundle checklist & ATB prophylaxis.[Internet].[cited 2023October 8].Available from: (in Thai)

Infection Control Committee,Faculty of Medicine, KhonKaen university. Manual for prevention and control in Srinagarind hospital. 2nd ed. Khon Kaen: KKU Printing;2019. (in Thai)

Kasatpibal N, Thongpiyapoom S, Narong MN,Suwalak N, Jamulitrat S. Extra charge and extra length of postoperative stay attributable to surgical site infection in six selected operations. J Med Assoc Thai. 2005;88(8):1083-91.PMID: 16404836.

Nakornping Hospital Database. CABG surgical site infectionrate; 2023.[cited 2024 February 28]. Available from: Thai)

AvsarP,Patton D, Ousey K, Blackburn J, O’Connor T,Moore Z. The impactof surgical site infection on health-related quality of life:a systematic review.Wound Manag Prev. 2021;67(6):10-9.PMID: 34284345.

Bamrasnaradura Infectious Disease Institute.Guideline for prevention and control in hospital. Bangkok: Aksorn Grphic and DesignPublishing; 2020. (in Thai)

Centers for Disease Control and Prevention.Surgical site infection event (SSI). [cited 2023 May 1]. Available from:

Phoon PHY, Hwang NC. Deep sternal wound infection:diagnosis, treatment and prevention.J Cardiothorac Vasc Anesth. 2020 ;34(6):1602-13. doi: 10.1053/j.jvca.2019.09.019.Epub2019Sep18.PMID:31623967.

Phanchai R. Epidemiology. 2018; [cited 2023 May 1].Available from: uploads/2017/12/textbookofepidemiological.pdf(in Thai)

Wongduan S, Yupares P. Prevention of surgical site infection. Journal of Nursing Sciences Chulalongkorn University. 2017;29(2):15-28. (in Thai)

Pan L, Tan S, Cao L, Feng X. Risk factor analysis and management strategies of operating room-related infections after coronary artery bypass grafting. J Thorac Dis. 2018;10(8):4949-56.doi: 10.21037/jtd.2018.08.01.PMID: 30233869;PMCID:PMC6129937.

Nooh E, Griesbach C, Rösch J, Weyand M, Harig F.Development of a new sternal dehiscence prediction scale for decision making in sternal closure techniques after cardiacsurgery. J CardiothoracSurg. 2021;16(1):174.doi: 10.1186/s13019-021-01555-2. PMID:


Ali U, Bibo L,PierreM, Bayfield N, Raichel L,Merry C,et al. Deep sternal wound infections after cardiac surgery:a new Australian tertiary centre experience. Heart Lung Circ. 2020;29(10):1571-8. doi: 10.1016/j.hlc.2020.02.003.Epub2020Mar7.PMID:32173262.

Furui M,Kong PK,Moorthy PSK,SoonCK,Akhtar KMA,Shamsuddin AM,DillonJ. Risk factors for sternal wound infection after coronary artery bypass grafting in patients with and without diabetes.IntHeartJ. 2022;63(3):426-32. doi: 10.1536/ihj.21-464. Epub 2022 May 14.

PMID: 35569962.

Brunet A, N’Guyen Y, Lefebvre A, Poncet A, Robbins A, Bajolet O, et al. Obesity and preoperative anaemia as independent risk factors for sternal wound infection after coronary artery bypass graft surgery with pedicled (nonskeletonized) internal mammary arteries: the role of thoracic wall ischemia? Vasc Health RiskManag. 2020;16:553-9. doi: 10.2147/VHRM.S264415. PMID:


Thelwall S,Harrington P,Sheridan E, Lamagni T. Impact of obesity on the risk of wound infection following surgery:results from a nationwide prospective multicentre cohort study in England. Clin Microbiol Infect. 2015;21(11):1008.e1-8. doi: 10.1016/j.cmi.2015.07.003.

Epub 2015 Jul 18.PMID: 26197212.

AtikFA,PegadoHM,deBrito LMR,MacedoMT,França EP Jr, Dias AKA, et al. Does the anthropometric profile influence infection morbidity after coronary artery bypass grafting? J Card Surg. 2021;36(4):1194-1200. doi:10.1111/jocs.15334. Epub 2021 Jan 19. PMID:

Song Y, Chu W, Sun J, Liu X, Zhu H, Yu H, Shen C.Review on risk factors, classification, and treatment of sternal wound infection. J Cardiothorac Surg.2023;18(1):184. doi: 10.1186/s13019-023-02228-y.PMID:37208736;PMCID:PMC10199640.

Celik S, Kirbas A, Gurer O, Yildiz Y, Isik O. Sternal dehiscence in patients with moderate and severe chronic obstructive pulmonary disease undergoing cardiac surgery:the value of supportive thorax vests. J Thorac Cardiovasc Surg. 2011;141(6):1398-402.doi: 10.1016/j.jtcvs.2011.01.042. Epub 2011 Mar 5.PMID: 21377699.

Sunsanee T, Sirilux T, Thanidawan W, Pornrundee N,Prapaporn M. Effects of pre-discharge Program for surgical wound care and infection prevention among patients in the private surgery ward of Buddha Sothorn Hospital, Chachoengsao Province. Journal of Phrapokklao Nursing College. 2015;26(1):48-59. (in Thai)

NicoliniF,Santarpino G, Gatti G, Reichart D, OnoratiF,Faggian G, et al. Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery:prospective, cohort studyfrom the E-CABG registry. Int JSurg. 2018;53:354-9.doi: 10.1016/j.ijsu.2018.04.021. Epub 2018 Apr 14.PMID: 29665452.

Gatti G,Perrotti A, Reichart D, Maschietto L, OnoratiF,Chocron S, et al. Glycated hemoglobin and risk of sternal wound infection after isolated coronary surgery. Circ J.2016;81(1):36-43.doi:10.1253/circj.CJ-16-0778.Epub 2016 Dec 8.PMID: 27928145.

Abuzaid AA, Zaki M, Al Tarief H.Potential risk factors for surgical site infection after isolated coronary artery bypass grafting in a Bahrain cardiac centre: a retrospective,case-แontrolled study. Heart Views. 2015;16(3):79-84. doi: 10.4103/1995-705X.164457. PMID:


Papadopoulos A,Machairas N, Tsourouflis G, Chouliaras C,ManiotiE,BroutasD,KykalosS,DaikosGL,Samarkos M, Vagianos C. Riskfactors for surgical siteinfections in patients undergoing emergency surgery: a single-centre experience. In Vivo. 2021;35(6):3569-74. doi:10.21873/invivo.12660.PMID: 34697196;PMCID:PMC8627714.

Pailin M, Nongyao K, Waraporn B. Web application development for post discharge surgical site infection surveillance.NursingJournal.2021;48(2):37-50.(inThai)

Feng TR, White RS, Gaber-Baylis LK, Turnbull ZA,Rong LQ. Coronary artery bypass graft readmission rates and risk factors - a retrospective cohort study. Int J Surg.2018;54(Pt A):7-17. doi: 10.1016/j.ijsu.2018.04.022. Epub 2018 Apr 17.PMID: 29678620.

Asia Pacific Society of Infection Control. The Apsic guidelines for the prevention of surgical site infections;2019 [cited 2023 August 1]. Available from:

Lohsiriwat V, Chinswangwatanakul V, Lohsiriwat D,Rongrungruang Y,Malathum K,Ratanachai P,ButsripoomB, Asdornwised U, Boontham P. Guidelines for the prevention of surgical site infection: the Surgical Infection Society of Thailand recommendations (executive summary). J Med Assoc Thai. 2020;103(1) 2020.05.11506.

Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S.Prevention and management of sternal wound infections.J Thorac CardiovascSurg. 2016;152(4):962-72.doi:10.1016/j.jtcvs.2016.01.060. Epub 2016 Aug 8.PMID: 27555340.

Cardiovascular thoracic intensive care unit,Sunpasitthiprasong hospital. Guideline for patient undergoing heart valve surgery;2017[cited2023August1].Available from: health/media/05ce6494c532c5dd5783ebc50eb5f076.pdf

(in Thai)

Kotnis-Gąska A, Mazur P, Olechowska-Jarząb A,Stanisz A, BulandaM, Undas A.sternal wound infections following cardiac surgery and their management: a single-centre study from the years 2016-2017. Kardiochir Torakochirurgia Pol. 2018 Jun;15(2):79-85. doi:

5114/kitp.2018.76472.Epub 2018 Jun 25.PMID:30069187;PMCID:PMC6066679.

MajidFM, BubaFM, BarryM, AlsharaniF, AlfawzanF.Incidence, types and outcomes of sternal wound infections after cardiac surgery in Saudi Arabia. a retrospective medical chart review. Saudi Med J. 2020;41(2):177-82. doi: 10.15537/smj.2020.2.24843. PMID:


Jenwiteesuk K. Basic wound healing and wound bed preparation.Srinagarind Medical Journal. 2013;28(4):10-17. (in Thai)

Nursing Department, Siriraj Hospital. Recommendation for patient self-care undergoing coronary artery bypass grafting; 2022. [cited 2023 September 11]. Available from: