A simple infection-control protocol to reduce serious cardiac device infections

Abstract

Aim: Device infection is a serious complication and is considered procedure-related if occurring within 12 months of an intervention. We analysed the effectiveness of a simple infection-control protocol (ICP) at reducing cardiac device infections (CDIs) in a tertiary referral centre. Methods and results: Prior to the introduction of a new ICP, we retrospectively analysed all simple and complex device implants, related procedures, and infectionsover a 3-year period.Anewprotocol wasimplemented fromNovember 2007, including antibiotic prophylaxis determined by risk stratification, improved glycaemic control, specific skin preparation, and closure techniques, as well as different diathermy settings. Follow-up data for all patientswere collected. Risk factors for infection were compared between pre- and post-intervention groups to ensure that the populationswere comparable.Acost analysis of CDI and a review of the commonly identified micro-organisms were also undertaken. Onethousand seven hundred and ninety-eight procedureswere performed betweenNovember 2004 andNovember 2007 and 981 procedures between November 2007 and May 2009. There were no significant differences in the risk factors for infection between the two groups. Following the introduction of the ICP, there was a 54% reduction in the incidence of CDI from 1.3 to 0.6% (P < 0.03; CI 0.25, 1.36). Most patients with CDI had negative blood cultures or grew Staphylococcus sp. The average costwas £30 958.40 per infection incident and the cost of the new ICP was minimal. Conclusions: A significant reduction in CDI can be achieved with the introduction of a simple ICP with substantial cost savings. Published on behalf of the European Society of Cardiology. All rights reserved.