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Prevention of Cardiac Implantable Electronic Device Infections: Single Operator Technique with Use of Povidone‐Iodine, Double Gloving, Meticulous Aseptic/Antiseptic Measures and Antibiotic Prophylaxis
Author(s) -
MANOLIS ANTONIS S.,
MELITA HELEN
Publication year - 2017
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12996
Subject(s) - medicine , antiseptic , cardiac resynchronization therapy , aseptic processing , implantable cardioverter defibrillator , surgery , antibiotic prophylaxis , single center , ejection fraction , asepsis , antibiotics , heart failure , pathology , microbiology and biotechnology , biology
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. Conclusion 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.