Date of Project Completion

Spring 2023

Document Type

Project Paper

Degree Name

Doctor of Nursing Practice



First Advisor

Julie Ponto

Second Advisor

Lori Rhudy





Purpose and rationale: Deep Sternal Wound Infections (DSWI) are associated with morbidity rates and mortality rates as high as 10% -15% as well as significantly increased hospital costs. The purpose of this project is to decrease current rates of DSWIs in adults undergoing cardiac surgery at a large medical institution.

Synthesis of evidence: The literature shows a strong relationship between elevated HbA1C and DSWI. All articles reviewed for this proposal which implement a sternal vest intervention support its use to prevent DSWI.

Practice change and implementation strategies: The strategy used to implement these evidence-based practice interventions includes four steps. These steps include creating awareness and interest, building knowledge and commitment, promoting action and adoption, and pursuing integration and sustained use. The Johns Hopkins Nursing Evidence-based Practice Model is implemented to guide this project proposal.

Evaluation: Data on DSWI rates among cardiac surgical patients will continue to be monitored and provide data to compare to pre-implementation. Process screening indicators, evaluation surveys, and real-time feedback will be analyzed to measure success.

Conclusions and implications for practice: Implementing an evidence-based intervention to address DSWI is proposed. Checking a patient’s HbA1C prior to surgery and referring them to endocrinology or their primary care provider for education if their HbA1C is above 8.0% is already a part of a different department project; for this reason, it was not further pursued. This DNP project’s focus is to implement a sternal support vest worn by high-risk patients as early as post-op day 0 (once in the ICU and stabilized) for at least six weeks postoperatively to protect and promote sternal healing, thus preventing an infection. This vest intervention will help to reduce DSWI rates within the department.

Included in

Nursing Commons