title: A simple infection-control protocol to reduce serious cardiac device infections.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  Prior to the introduction of a new ICP, we retrospectively analysed all simple and complex device implants, related procedures, and infections over a 3-year period. A new protocol was implemented from November 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 patients were collected. Risk factors for infection were compared between pre- and post-intervention groups to ensure that the populations were comparable. A cost analysis of CDI and a review of the commonly identified micro-organisms were also undertaken. One thousand seven hundred and ninety-eight procedures were performed between November 2004 and November 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 cost was £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.
authors.affiliation: The Heart Hospital, Institute of Cardiovascular Sciences, 16-18 Westmoreland Street, London W1G 8PH, UK syedyahsan@googlemail.com.
authors.forename: Syed Y
authors.initials: SY
authors.lastname: Ahsan
authors.affiliation: The Heart Hospital, Institute of Cardiovascular Sciences, 16-18 Westmoreland Street, London W1G 8PH, UK.
authors.forename: Bunny
authors.initials: B
authors.lastname: Saberwal
authors.affiliation: The Heart Hospital, Institute of Cardiovascular Sciences, 16-18 Westmoreland Street, London W1G 8PH, UK.
authors.forename: Pier D
authors.initials: PD
authors.lastname: Lambiase
authors.affiliation: The Heart Hospital, Institute of Cardiovascular Sciences, 16-18 Westmoreland Street, London W1G 8PH, UK.
authors.forename: Chieh Y
authors.initials: CY
authors.lastname: Koo
authors.affiliation: The Heart Hospital, Institute of Cardiovascular Sciences, 16-18 Westmoreland Street, London W1G 8PH, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Lee
authors.affiliation: The Heart Hospital, Institute of Cardiovascular Sciences, 16-18 Westmoreland Street, London W1G 8PH, UK.
authors.forename: Aerokondal B
authors.initials: AB
authors.lastname: Gopalamurugan
authors.affiliation: The Heart Hospital, Institute of Cardiovascular Sciences, 16-18 Westmoreland Street, London W1G 8PH, UK.
authors.forename: Dominic P
authors.initials: DP
authors.lastname: Rogers
authors.affiliation: The Heart Hospital, Institute of Cardiovascular Sciences, 16-18 Westmoreland Street, London W1G 8PH, UK.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Lowe
authors.affiliation: The Heart Hospital, Institute of Cardiovascular Sciences, 16-18 Westmoreland Street, London W1G 8PH, UK.
authors.forename: Anthony W C
authors.initials: AW
authors.lastname: Chow
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis; D017147:Defibrillators, Implantable; D020878:Device Removal; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Implantation; Infection; Outcomes; Prevention; Quality improvement