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Prevention of Infections Associated With Permanent Cardiac Antiarrhythmic Devices by Implementation of a Comprehensive Infection Control Program

Published online by Cambridge University Press:  02 January 2015

Abraham Borer*
Infectious Disease Institute, Beer-Sheva, Israel
Jacob Gilad
Infectious Disease Institute, Beer-Sheva, Israel Department of Health System Management, Faculty for Health Sciences, Beer-Sheva, Israel
Eytan Hyam
Hospital Administration, Beer-Sheva, Israel
Francisc Schlaeffer
Infectious Disease Institute, Beer-Sheva, Israel Hospital Administration, Beer-Sheva, Israel Quality Unit, Beer-Sheva, Israel
Seada Eskira
Infectious Disease Institute, Beer-Sheva, Israel
Phany Aloni
Cardiology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Abraham Wagshal
Cardiology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Amos Katz
Cardiology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Infectious Disease Institute, Soroka University Medical Center, P. O. Box 151, Beer-Sheva 84101, Israel



To implement a comprehensive infection control (IC) program for prevention of cardiac device-associated infections (CDIs).


Prospective before-after trial with 2 years of follow-up.


A tertiary-care, university-affiliated medical center.


A consecutive sample of all adults undergoing cardiac device implantation between 1997 and 2002.


An IC program was implemented during late 2001 and included staff education, preoperative modification of patient risk factors, intraoperative control of strict aseptic technique, surgical scrubbing and attire, control of environmental risk factors, optimization of antibiotic prophylaxis, postoperative wound care, and active surveillance. The clinical endpoint was CDI rates.


Between 1997 and 2000, there were 7 CDIs among 725 procedures (mean annual CDI incidence, 1%). During the first 9 months of 2001, there were 7 CDIs among 167 procedures (4.2%; P = .007): CDIs increased from 7 among 576 to 3 among 124 following pacemaker implantation (P = .39) and from 0 among 149 to 4 among 43 following cardioverter-defibrillator implantation (P = .002). Of the 14 CDIs, 5 involved superficial wounds, 7 involved deep wounds, and 2 involved endocarditis. Following intervention, there were no cases of CDI among 316 procedures during 24 months of follow-up (4.2% reduction; P = .0005).


We observed a high CDI rate associated with substantial morbidity. IC measures had an impact on CDI. Although the relative weight of each measure in the prevention of CDI remains unknown, our results suggest that implementation of a comprehensive IC program is feasible and efficacious in this setting.

Original Articles
Copyright © The Society for Healthcare Epidemiology of America 2004

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1.Da Costa, A, Lelievre, H, Kirkorian, G, et al.Role of the preaxillary flora in pacemaker infections: a prospective study. Circulation 1998;97:17911795.CrossRefGoogle ScholarPubMed
2.Kearny, RA, Eisen, HJ, Wolf, JE. Nonvalvular infections of the cardiovascular system. Ann Intern Med 1994;121:219230.CrossRefGoogle Scholar
3.Hill, PE. Complications of permanent transvenous cardiac pacing: a 14-year review of all transvenous pacemakers inserted at one community hospital. Pacing Clin Electrophysiol 1987;10:564570.CrossRefGoogle ScholarPubMed
4.Giamarellou, H. Nosocomial cardiac infections. J Hosp Infect 2002;50:91105.CrossRefGoogle ScholarPubMed
5.Chamis, AL, Peterson, GE, Cabell, CH, et al.Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators. Circulation 2001;104:10291033.CrossRefGoogle ScholarPubMed
6.Da Costa, A, Kirkorian, G, Cucherat, M. Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis. Circulation 1998;97:17961801.CrossRefGoogle ScholarPubMed
7.Gregoratos, J, Abrams, G, Epstein, AE, et al.ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemaker and antiar-rhythmia devices: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2002;106:21452161.CrossRefGoogle Scholar
8.Mangram, AJ, Horan, TC, Pearson, ML, et al.Guideline for prevention of surgical site infection, 1999. Am J Infect Control 1999;27:97134.CrossRefGoogle ScholarPubMed
9.Larson, E. APIC guideline for handwashing and hand antisepsis in healthcare settings. Am J Infect Control 1995;23:251269.CrossRefGoogle Scholar
10.Global consensus conference: final recommendations. Am J Infect Control 1999;27:503513.CrossRefGoogle ScholarPubMed
11.Sheckler, WE, Brimhall, D, Buck, AS, et al.Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Infect Control Hosp Epidemiol 1998;19:114124.CrossRefGoogle Scholar
12.Spinier, SA, Nawarskas, JJ, Foote, EF, et al.Clinical presentation and analysis of risk factors for infectious complications of implantable cardioverter-defibrillator implantations at a university medical center. Clin Infect Dis 1998;26:11111116.CrossRefGoogle Scholar
13.Lai, KK, Fontecchio, SA. Infections associated with implantable cardioverter defibrillators placed intravenously and via thoracotomies: epidemiology, infection control, and management. Clin Infect Dis 1998;27:265269.CrossRefGoogle Scholar
14.Gelfand, MS, Simmons, BP, Schoettle, P, et al.Cefamandole versus cefonicid prophylaxis in cardiovascular surgery: a prospective study. Ann Thorac Surg 1990;49:435439.CrossRefGoogle Scholar
15.Beery, TA, Baas, LS, Hickey, CS. Infection precautions with temporary pacing leads: a descriptive study. Heart Lung 1996;25:182189.CrossRefGoogle ScholarPubMed
16.Jacobson, B, Bluhm, G, Julander, I, et al.Coagulase-negative staphylococci and cloxacillin prophylaxis in pacemaker surgery. Acta Pathol Microbiol Scand 1983;91:9799.Google ScholarPubMed
17.Kampf, G, Gastmeier, P, Wischnewski, N, et al.Analysis of risk factors for nosocomial infections: results from the first national prevalence study in Germany (NIDEP study, part 1). J Hosp Infect 1997;37:103112.CrossRefGoogle Scholar
18.Emmerson, AM, Enstone, JE, Griffin, M, et al.The second national prevalence survey of infection in hospitals: overview of the results. J Hosp Infect 1996;32:175180.CrossRefGoogle ScholarPubMed
19.Wilson, APR. Surveillance of wound infections. J Hosp Infect 1995;9:8186.CrossRefGoogle Scholar
20.Angelillo, IF, Mazziotta, A, Nicotera, G, et al.Nurses and hospital infection control: knowledge, attitudes and behavior of Italian operating theatre staff. J Hosp Infect 1999;42:105112.CrossRefGoogle Scholar
21.Larson, E, Kertzer, EK. Compliance with handwashing and barrier precautions. J Hosp Infect 1995;30(suppl):88106.CrossRefGoogle Scholar
22.Jenner, EA, Mackintosh, C, Scott, GM. Infection control: evidence into practice. J Hosp Infect 1999;42:91104.CrossRefGoogle Scholar
23.Condon, RE, Schulte, WJ, Malangoni, MA, et al.Effectiveness of a surgical wound infection surveillance program. Arch Surg 1983;118:303307.CrossRefGoogle Scholar
24.Haley, RW, Culver, DH, White, JW, et al.The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182205.CrossRefGoogle Scholar
25.Olson, MM, Lee, JT. Continuous, 10-year wound infection surveillance. Arch Surg 1990;125:794803.CrossRefGoogle ScholarPubMed
26.McConkey, SJ, L'Ecuyer, PB, Murphy, DM, et al.Results of a comprehensive infection control program for reducing surgical-site infections in coronary artery bypass surgery. Infect Control Hosp Epidemiol 1999;20:533538.CrossRefGoogle ScholarPubMed
27.Borer, A, Gilad, J, Meydan, N, et al.Impact of active monitoring of infection control practices on deep sternal infection after open-heart surgery. Ann Thorac Surg 2001;72:515520.CrossRefGoogle ScholarPubMed