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Real-world effectiveness of infection prevention interventions for reducing procedure-related cardiac device infections: Insights from the veterans affairs clinical assessment reporting and tracking program

Published online by Cambridge University Press:  04 June 2019

Archana Asundi ,
Maggie Stanislawski ,
Payal Mehta ,
Anna E. Baron ,
Hillary J. Mull ,
P. Michael Ho ,
Peter J. Zimetbaum ,
Kalpana Gupta  and
Westyn Branch-Elliman
Archana Asundi
Affiliation:
Division of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
Maggie Stanislawski
Affiliation:
Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, and Denver, Colorado Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado Division of Cardiology, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
Payal Mehta
Affiliation:
Department of Medicine, Division of Infectious Diseases, Boston VA Healthcare System, West Roxbury, Massachusetts
Anna E. Baron
Affiliation:
Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado
Hillary J. Mull
Affiliation:
Center for Healthcare Organization and Implementation Research (CHOIR), Boston Veterans Affairs Healthcare System, Boston, Massachusetts
P. Michael Ho
Affiliation:
Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, and Denver, Colorado Division of Cardiology, Rocky Mountain Regional VA Medical Center, Aurora, Colorado Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
Peter J. Zimetbaum
Affiliation:
Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Kalpana Gupta
Affiliation:
Department of Medicine, Division of Infectious Diseases, Boston VA Healthcare System, West Roxbury, Massachusetts Center for Healthcare Organization and Implementation Research (CHOIR), Boston Veterans Affairs Healthcare System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Westyn Branch-Elliman*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Boston VA Healthcare System, West Roxbury, Massachusetts Center for Healthcare Organization and Implementation Research (CHOIR), Boston Veterans Affairs Healthcare System, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
*
Author for correspondence: Westyn Branch-Elliman, Email: wbranche@bidmc.harvard.edu
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Abstract

Objective:

To measure the association between receipt of specific infection prevention interventions and procedure-related cardiac implantable electronic device (CIED) infections.

Design:

Retrospective cohort with manually reviewed infection status.

Setting:

Setting: National, multicenter Veterans Health Administration (VA) cohort.

Participants:

Sampling of procedures entered into the VA Clinical Assessment Reporting and Tracking-Electrophysiology (CART-EP) database from fiscal years 2008 through 2015.

Methods:

A sample of procedures entered into the CART-EP database underwent manual review for occurrence of CIED infection and other clinical/procedural variables. The primary outcome was 6-month incidence of CIED infection. Measures of association were calculated using multivariable generalized estimating equations logistic regression.

Results:

We identified 101 procedure-related CIED infections among 2,098 procedures (4.8% of reviewed sample). Factors associated with increased odds of infections included (1) wound complications (adjusted odds ratio [aOR], 8.74; 95% confidence interval [CI], 3.16–24.20), (2) revisions including generator changes (aOR, 2.4; 95% CI, 1.59–3.63), (3) an elevated international normalized ratio (INR) >1.5 (aOR, 1.56; 95% CI, 1.12–2.18), and (4) methicillin-resistant Staphylococcus colonization (aOR, 9.56; 95% CI, 1.55–27.77). Clinically effective prevention interventions included preprocedural skin cleaning with chlorhexidine versus other topical agents (aOR, 0.41; 95% CI, 0.22–0.76) and receipt of β-lactam antimicrobial prophylaxis versus vancomycin (aOR, 0.60; 95% CI, 0.37–0.96). The use of mesh pockets and continuation of antimicrobial prophylaxis after skin closure were not associated with reduced infection risk.

Conclusions:

These findings regarding the real-world clinical effectiveness of different prevention strategies can be applied to the development of evidence-based protocols and infection prevention guidelines specific to the electrophysiology laboratory.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 8 , August 2019 , pp. 855 - 862
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: This work was presented as a poster abstract (no. 2126) at IDWeek 2018, on October 6, 2018, in San Francisco, California.

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