title: Prevention of Cardiac Implantable Electronic Device Infections: Single Operator Technique with Use of Povidone-Iodine, Double Gloving, Meticulous Aseptic/Antiseptic Measures and Antibiotic Prophylaxis.
abstract: BACKGROUND
  Cardiac implantable electronic device (CIED) implantation is complicated by infection still at a worrisome rate of 2-5%. Since early on during device implantation procedures, we have adopted an infection-preventive technique which has hitherto resulted in effective prevention of infections. Herein we present our results of applying this technique by a single operator in a prospective series of 762 consecutive patients undergoing device implantation.
  
  
  METHODS
  A meticulous search for and treatment of active, occult, or smoldering infection was undertaken preoperatively. An aseptic/antiseptic technique was used for implantation of each device. Skin preparation is thorough with initial cleansing performed with alcohol followed by povidone-iodine 10% solution, which is also used in the wound and inside the pocket. In addition, we routinely use double gloving, and IV antibiotic prophylaxis 1 hour before and for 48 hours afterwards followed by oral antibiotic for 2-3 days after discharge. The skin is closed with absorbable sutures. The study includes 382 patients having a new pacemaker (n = 333) or battery change, system upgrade or lead revision (n = 49), and 380 patients having a new implantable cardioverter-defibrillator (ICD) (n = 296) or device replacement/upgrade/lead revision (n = 84).
  
  
  RESULTS
  The pacemaker group, aged 70.2 ± 16.5 years, includes 18% VVI, 49% DDD, 29% VDD, and 4% cardiac resynchronization therapy (CRT) devices. The ICD group, aged 61.3 ± 13.0 years, with a mean ejection fraction of 36 ± 13%, includes 325 ICD and 55 CRT implants. Over 26.6 ± 33.4 months for the pacemaker group and 36.6 ± 38.3 months for the ICD group, infection occurred in one patient in each group (0.26%) having a device replacement.
  
  
  CONCLUSIONS
  A consistent and strict approach of aseptic/antiseptic technique with the use of double gloving and povidone-iodine solution within the pocket plus a 4-day regimen of antibiotic prophylaxis minimizes infections in CIED implants.
authors.affiliation: Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
authors.forename: Antonis S
authors.initials: AS
authors.lastname: Manolis
authors.affiliation: Central Laboratories, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Melita
mesh_terms: D000279:Administration, Cutaneous; D061605:Administration, Intravenous; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005932:Gloves, Surgical / Q000706:statistics & numerical data; D006115:Greece / Q000453:epidemiology; D063373:Hand Hygiene / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011206:Povidone-Iodine / Q000008:administration & dosage*; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine
keywords: antibiotic prophylaxis; cardiac implantable electronic devices; cardiac resynchronization therapy; defibrillators; endocarditis; infections; pacemakers