Eliminating Postoperative Infections on a Budget
Collaborative Quality Improvement for Congenital Heart Surgery in Low- and Middle-Income Countries
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Congenital heart surgery outcomes have improved dramatically since the last part of the 20th century in high-income countries. Through dissemination of knowledge across the globe, congenital heart surgery became feasible in low- and middle-income countries (LMICs).1 Hospitals in these nations developed congenital heart surgery programs initially to treat patients with simple lesions amenable to complete repair, and many of these programs demonstrate excellent results despite a relative lack of resources.2,3 In light of these successes, hospitals in LMICs now tackle more complex cases such as neonatal repairs and those that require multistage palliation (eg, functional single ventricle).
See Article by Sen et al
In this context, LMIC hospitals face serious challenges in perioperative care arising from complex surgical cases as a result of a longer period of critical illness and hospital stay: prolonged mechanical ventilation, impaired nutrition, and greater risk of infection.4 Postoperative infections have been the subject of intense study and the focus of several well-resourced, successful quality improvement initiatives to reduce their frequency in North America.5,6 As a result, serious bacterial infections—bloodstream infections, deep surgical site infections, and sepsis requiring cardiopulmonary support—are now relatively uncommon after congenital heart surgery in this setting, and postoperative infections are rarely a primary complication.7
However, the epidemiology of postoperative infections after congenital heart surgery in LMICs may be quite different. Greater poverty; malnutrition; more frequent preoperative infections, including tuberculosis, Gram-negative bacteremia, malaria, and neglected tropical diseases; and more limited primary care in LMICs likely increase predisposition to postoperative infection in these …