Prevention of infections associated with permanent cardiac antiarrhythmic devices by implementation of a comprehensive infection control program.
OBJECTIVE
To implement a comprehensive infection control (IC) program for prevention of cardiac device-associated infections (CDIs).


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


METHODS
A tertiary-care, university-affiliated medical center.


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


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Borer
Abraham
A
Infectious Disease Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Gilad
Jacob
J
Hyam
Eytan
E
Schlaeffer
Francisc
F
Schlaeffer
Pnina
P
Eskira
Seada
S
Aloni
Phany
P
Wagshal
Abraham
A
Katz
Amos
A
D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000382:microbiology* / Q000706:statistics & numerical data; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000382:microbiology*; D017410:Practice Guidelines as Topic; D016730:Program Development; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*