Implementation of a Surgical Site Infection Prevention Bundle in the Cardiac Electrophysiology Laboratory for Management of a Cluster of Cardiac Device Infections

Background: Cardiac device infection (CIED-I) rates in our VA facility historically are low (<1%). However, over a 3 month period, we identified a cluster of 4 CIED-Is (2 PPMs & 2 ICDs). There is not a standardized prevention checklist designed for the electrophysiology laboratory, thus we applied a bundle of interventions designed for SSI prevention to CIED procedures. Effective bundled interventions include preoperative chlorhexidine (CHG) baths, intranasal MRSA decolonization with iodine or mupirocin, weight based antibiotic dosing (WBAD), antibiotics given within a peri-operative window, & addition of vancomycin (V) for MRSA colonized patients.

Methods: Chart review of cluster cases was undertaken, & key stakeholders were interviewed pre & post-intervention to determine contributing factors & barriers to implementation. SSI prevention strategies were also considered. Based on stakeholder input, a multi-faceted intervention was implemented.

Results: Major contributing factors to 4 CIED-I (MRSA (1), MSSA (1), E. coli (1), GAS (1)) include: Prophylactic antibiotics given post-procedure, failure to follow up on MRSA screening, no procedure stop for elevated INR in the setting of Coumadin use. Errors in antimicrobial dosing & choice were also identified. After implementation of the Bundle, no further infections were identified, but EP lab staff note that pre-operative vancomycin infusion remains a challenge due to facility barriers.

Conclusion: There is a need for a standard prevention bundle to reduce CIED-I. Implementation of simple interventions can reduce CIED-Is, but further research is necessary to identify which interventions are feasible & cost-effective. Another challenge in the EP lab is improving antimicrobial use.

Findings	Bundle
High INR in patients with A-fib	INR cut off
No pre-op CHG bathing or any bathing recommendations	CHG bathing
MRSA results not acted upon	Pre-procedural intranasal iodine for everyone
V use driven by allergies, not MRSA status	V for MRSA + and PCN allergy only
No WBAD or redosing (RD) for prolonged procedures.	WBAD for V & C & RD C for >4 hours
Prophylactic antibiotics given after incision or after completion of procedure	V infusion starts at least 60 minutes & C 30 minutes prior to procedure.

Judith Strymish, MD^1,2, Barbara Welch, RN¹, Adelqui Peralta, MD^2,3, Peter Hoffmeister, MD^3,4, Westyn Branch-Elliman, MD^1,2, Kalpana Gupta, MD, MPH⁵ and VA Boston Infection Prevention and Control Unit, (1)Medicine, VA Boston HCS, West Roxbury, MA, (2)Harvard Medical School, Boston, MA, (3)VA Boston HCS, West Roxbury, MA, (4)Boston University School of Medicine, Boston, MA, (5)VA/Boston & Boston Univeristy School of Medicine, Boston, MA

Disclosures:

J. Strymish, None

B. Welch, None

A. Peralta, None

P. Hoffmeister, None

W. Branch-Elliman, None

K. Gupta, None

See more of: HAI: Surgical Site Infections
See more of: Poster Abstract Session

<< Previous Abstract | Next Abstract >>