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Cardiac electrophysiology laboratories lack interventions to prevent infections
Recent survey results indicating limited use of infection prevention and antimicrobial stewardship practices in cardiac electrophysiology laboratories underscore the need to improve infection control measures in these facilities, according to researchers.
The number of procedures for implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter-defibrillators, are on the rise, increasing the incidence of CIED infections, Preeti Mehrotra, MD, MPH, of the department of medicine at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, and colleagues reported. Severe infections are associated with an 18% mortality rate and cost more than $50,000 per event.
“The rising use of CIED devices, particularly due to a growing geriatric population coupled with the devastating nature of CIED infections, creates a critical need for effective infection prevention strategies in the cardiac electrophysiology (EP) laboratory,” they wrote in Infection Control & Hospital Epidemiology.
Previous studies have demonstrated high rates of inappropriate antimicrobial stewardship practices following CIED procedures. To better understand infection control strategies implemented in EP laboratories, Mehrotra and colleagues distributed a cross-sectional survey to 109 institutions actively participating in the Society for Healthcare Epidemiology in America Research Network (SHEA-RN). Thirty-eight percent of the facilities responded to the survey. Among them, 41% (n = 17) provided complete data.
Although most institutions had basic infection prevention practices in place, few reported having more targeted interventions, according to the researchers. Forty-one percent of institutions (n = 7) with complete data indicated that they have a surveillance program for monitoring CIED infections; however, only three could characterize a mechanism for reporting infections. In addition, only 18% of infection prevention programs had denominator data.
“These data suggest that systematic and active surveillance programs — effective measures for reducing other types of heath care–associated infections — are rare,” Mehrotra and colleagues wrote.
In other results, 88% of responding institutions reported using preprocedural antimicrobial prophylaxis, which the researchers noted is a “highly effective and established measure for reducing CIED infections.” However, 35% prescribed postprocedural antimicrobials 76% to 100% of the time, despite a lack of evidence supporting their use, the researchers said. The most common regimen was cephalexin for 5 to 7 days.
“Although the study was limited by a small number of participating institutions, facilities that responded tended to be moderate-to-high–volume procedural centers that may be more likely to have formalized infection prevention and stewardship activities than smaller, nonteaching facilities,” Mehrotra and colleagues concluded. “Results from our survey suggest that the EP laboratory may benefit from increased infection prevention interventions and attention to large-scale quality improvement initiatives around antimicrobial stewardship.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.