2022 Quality Summit ePosters (Non-CE) - EP Device Implant Registry-2. Improved Infection Outcomes in Cardiovascular Implantable Electronic Devices, an EP Lab Quality Improvement Initiative

2. Improved Infection Outcomes in Cardiovascular Implantable Electronic Devices, an EP Lab Quality Improvement Initiative

Back to course

Pdf Summary

The study conducted by the Department of Cardiovascular Medicine at the University of Kansas Medical Center aimed to improve infection outcomes in cardiovascular implantable electronic devices (CIED). CIED infections are associated with significant morbidity and mortality, and the long-term mortality in patients with CIED infection is higher compared to non-infected patients. The study identified an increase in CIED infection rates and implemented various interventions to reduce infections.<br /><br />The interventions included changing dosing protocols of dual anti-platelets and anticoagulant medication, requiring technicians to double glove during draping and change outer gloves, and requiring all physicians to be gowned by technicians, double glove, and change outer gloves prior to handling new generators. Other interventions included the use of monofilament sutures and Dermabond for closure, requiring high-risk patients to use antimicrobial pouches, and applying pressure dressings for patients on anticoagulation therapy.<br /><br />The study monitored adherence to the interventions and infection rates, and the results showed a reduction in infection rates from 1.9% to 0.8% after 11 months of implementing the interventions. The infected devices included denovo pacemakers, CRT-D devices, and lead revisions, with bacteremia and concomitant pocket infection present in most cases.<br /><br />The study emphasized the importance of a multidisciplinary approach and multiple interventions to reduce CIED infections effectively. It also highlighted the need for continuous monitoring and adjustment of interventions, as one particular intervention was reversed due to absorption problems with the new suture material.<br /><br />Overall, the study demonstrated the benefit of a quality improvement initiative in reducing CIED infections in the electrophysiology lab. The findings can serve as a guide for other institutions to implement similar strategies and improve infection outcomes in patients with CIED.

Keywords

CIED infections

Interventions

Dosing protocols

Double glove technique

Monofilament sutures

Antimicrobial pouches

Pressure dressings

Infection rates

Bacteremia

Quality improvement initiative