Abstract 10041: Skin Preparation Reduces Cardiac Implantable Device Infections
Introduction: A recently reported increase in cardiac implantable electronic device (CIED) infections is disproportionate to the increase in implants. The culprit organism in most CIED infections is some form of staphylococcal bacteria.
Hypothesis: We hypothesized changes in skin preparation prior to and during the procedure would reduce the incidence of CIED infections.
Methods: Three interventions identified by a multidisciplinary team were implemented at our institution starting Nov. 15, 2009. Process changes were: 1) avoidance of antibiotic pocket flushing; 2) preoperative skin washing with chlorhexidine gluconate 4% solution the night before and morning of implant procedure; and 3) strict 3-minute dry time after surgical skin preparation with chlorhexidine gluconate 2% and isopropyl alcohol 70% at time of implantation. Implant data from Jan. 2008 to Oct. 2010 (n=3873, mean age 71 ± 13 yr, male 61%, Caucasian 88%) were reviewed. Population characteristics and CIED infection rates were compared before (n=2622) and after (n=1251) implementation of process changes. Average follow-up was 22.1 mo. Kaplan-Meier method was used to calculate estimated infection rates and Cox regression to identify infection predictors.
Results: Comorbidities (CAD, cardiomyopathy, diabetes, hypertension, hemodialysis, use of glucocorticoids) were similar in both groups. There was slightly less primary implantation (47% vs. 41%, p=0.001), warfarin use (28% vs. 25%, p=0.02) and prior transvenous temporary pacing (4.7% vs. 2.7%, p=0.0035) in the postintervention group. However, univariate and bivariate analyses showed no statistically significant effect on CIED infection risk. Antibiotic pocket flushing was reduced from 73% to 28% post-interventions. During study period, 30 CIED infections occurred. After implementation of interventions, CIED infection rate at 12 months post-implant decreased from 1% (n=27) to 0.24% (n=3), p=0.01 (hazard ratio: 4.2; 95% CI: 1.28-13.86) with similar results at 3- and 6-month follow-up.
Conclusion: Multidisciplinary interventions (avoidance of antibiotic pocket flushing, additional preoperative skin washing and 3-minute dry time after surgical skin preparation) significantly reduce post-CIED infections.
- © 2011 by American Heart Association, Inc.