Which combination of practices is most effective in reducing mediastinitis after CABG?

• A. Glycemic control, antibiotic prophylaxis, sterile technique, sternal closure, and wound care.
• B. Avoid prophylactic antibiotics.
• C. Rely only on postoperative bed rest.
• D. Sterile technique is optional.

Answer: (A)

Preventing mediastinitis after CABG hinges on a multi-pronged infection-prevention approach that starts in the operating room and extends into the postoperative period. Glycemic control helps by reducing impaired immune function and poor wound healing associated with high blood glucose, lowering the risk of deep wound infections, especially in diabetics. Antibiotic prophylaxis reduces bacterial load at the incision when given at the right time and with the appropriate agent, making it a frontline defense against perioperative infection. Sterile technique minimizes the chance of introducing organisms into the surgical field, which is crucial for preventing contamination. Secure sternal closure promotes stability and proper healing of the sternum, reducing dead space and tissue trauma that can harbor infection. Meticulous postoperative wound care, including dressing, drainage management, and early detection of problems, supports an orderly healing process and prevents wound contamination from outward sources. When these elements are combined, they address infection risk at multiple stages and align with best practices for preventing mediastinitis after CABG. Neglecting prophylactic antibiotics, relying on postoperative bed rest alone, or treating sterile technique as optional would leave the patient exposed to higher infection risk because those approaches fail to cover critical infection-control factors.