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

Research output: Contribution to journalArticle

Authors

  • Archana Asundi
  • Maggie Stanislawski
  • Payal Mehta
  • Anna E. Baron
  • Hillary J. Mull
  • P. Michael Ho
  • Peter J. Zimetbaum
  • Kalpana Gupta
  • Westyn Branch-Elliman

External Institution(s)

  • Boston University
  • Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care
  • Colorado State University
  • VA Medical Center
  • VA Boston Healthcare System and Boston University Schools of Public Health and Medicine
  • Boston Veterans Healthcare System
  • University of Colorado Denver
  • Harvard University

Details

Original languageEnglish (US)
Pages (from-to)855-862
Number of pages8
JournalInfection Control and Hospital Epidemiology
Volume40
Issue number8
StatusPublished - Aug 1 2019
Peer-reviewedYes

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.

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Asundi, A, Stanislawski, M, Mehta, P, Baron, AE, Mull, HJ, Ho, PM, Zimetbaum, PJ, Gupta, K & Branch-Elliman, W 2019, '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', Infection Control and Hospital Epidemiology, vol. 40, no. 8, pp. 855-862. https://doi.org/10.1017/ice.2019.127