1452. Don’t Pace Right Past the Sink: Electrophysiology Sterility Practices in the Face of Absent Guidelines
Session: Poster Abstract Session: HAI: Surgical Site Infections
Friday, October 28, 2016
Room: Poster Hall
  • CathLabPoster .pdf (1.0 MB)
  • Background: Post-implantation infection of cardiac implantable devices (CIDs) occur in up to 5.7% of implantations and may manifest as pocket infections, or in more serious cases, endocarditis requiring lead removal. Serially updated guidelines for CID use do not offer recommendations for sterility practices during device implantation. Without well-organized guidelines, sterility practices performed by CID operators may be inconsistent and inadequate. We present data regarding adherence to sterility best practices for CID cases at a tertiary care center.

    Methods: Two secret shoppers surveyed sterility practices at a tertiary care center’s cath lab. Procedures observed were all implants and generator exchanges for implantable cardiac defibrillators (ICDs), permanent pacemakers (PPMs) and subcutaneous ICDS (S-ICDs) from April 1st to April 29th 2016. Recorded events included scrubbing time, use of sterile garb, use of chlorhexidine gluconate site preparation, appropriate and timely antibiotic administration, and staff traffic during the procedure.

    Results: 35 procedures were observed in the study period. Ninety-seven percent of cases had at least one instance of scrubbing time less than the 6 minute manufacturer recommendation. Mean scrub time for fellows and attendings were 3.9 and 3.2 minutes, respectively. Sterile garb breaches occurred in 13/35 cases (37%) with mask breaches occurring 11 times (31% of cases) and gown breaches 3 times (8.6% of cases). There were 6 cases of 35 (17%) with incorrect use of CHG site prep. Antibiotics were appropriate with use of 1-2 grams of cephazolin based on patient weight substituted with vancomycin in cases of beta-lactam allergy. There were breaches in sterile technique in 3 cases (8.6%) due to operators touching objects outside the sterile field. Sixty-percent of cases had traffic breaches due to opening the hallway door more than twice or leaving doors open longer than 30 minutes after the sterile kit was opened.

    Conclusion: Sterility procedures in the cath lab are important, but performance is inconsistent. Sterility guidelines specifically for CID implantation may prove a useful tool to reduce infection rates.

    Ignacio De Cicco, MD1, Cameron Mcbride, BS2, Anne Dougherty, MD3, Oscar Rosales, MD4 and Luis Ostrosky-Zeichner, MD, FIDSA, FSHEA4, (1)Department of Internal Medicine, University of Texas McGovern Medical School at Houston, Houston, TX, (2)Medical School, McGovern Medical School, Houston, TX, (3)Electrophysiology, McGovern Medical School, Houston, TX, (4)McGovern Medical School, Houston, TX


    I. De Cicco, None

    C. Mcbride, None

    A. Dougherty, None

    O. Rosales, None

    L. Ostrosky-Zeichner, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.