Review of medical literature shows that the degree of hyperglycemia in the postoperative period was correlated with the rate of surgical site infection in patients undergoing major cardiac surgery (Lthan. Infection Control and Hospital Epidemiology. 2001;22:607; Dellinger. Infection Control and Hospital Epidemiology. 2001;22:604). Other articles have demonstrated that stingent glucose control in surgical intensive care unit patients reduces mortality (Van den Berghe. New England Journal of Medicine. 2001;345:1359).

*NOTE:

1. "Glucose control" is defined as serum glucose levels below 200 mg/dl, collected once on each of the first two postoperative days.
2. Tight glycemic control (e.g., using an insulin drip) is often performed in an intensive care setting or equivalent for safety.

Changes for Improvement

• Implement a glucose control protocl (sliding scale or insulin drip)
• Develop one protocol to be used for all surgical patients
• Regularly check preoperative blood glucose levels on all patients to identify hyperglycemia; this is best done early enough that the  assessment of risk can be completed and treatment initiated if appropriate
• Assign responsibility and accountability for blood glucose monitoring and control