Prevention of Cardiac Implantable Electronic Device Infections: Single Operator Technique with Use of Povidone‐Iodine, Double Gloving, Meticulous Aseptic/Antiseptic Measures and Antibiotic Prophylaxis

Manolis, Antonis S.; Melita, Helen

doi:10.1111/pace.12996

Cited by 16 publications

(9 citation statements)

References 33 publications

(94 reference statements)

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“…In addition to the risk of infection posed by nonscrubbed team members, there also is a risk for transmission of microbes through the sterile gloves of any surgical team member that may cause an infection. Current evidence supports surgical hand scrubs (preferably brushless) and double‐gloving . Brushless hand‐scrubbing techniques reduce the instance of microscopic cuts on the dermis and the excessive defoliation of skin cells while cleansing the skin surface of pathogens .…”

Section: Strategies To Prevent Ssismentioning

confidence: 99%

Perioperative Strategies for Surgical Site Infection Prevention

Bashaw¹

2018

AORN Journal

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To provide the learner with knowledge of best practices related to perioperative strategies for surgical site infection (SSI) prevention. OBJECTIVES1. Identify contributing patient factors related to SSI development. 2. Identify contributing procedural factors related to SSI development. 3. Describe perioperative best practices to help decrease the incidence of SSIs. 4. Describe two types of skin antiseptic agents that may be used for perioperative skin preparation. ACCREDITATIONAORN is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.ABSTRACT Surgical site infections (SSIs) are some of the most common and costly health care-associated infections. Although the rate of SSIs has declined significantly in the past decade, patient safety remains at risk. Perioperative nurses employ a variety of evidence-based best practices to prevent SSIs and facilitate a safe surgical experience for their patients, including hand hygiene, preoperative patient skin antisepsis, and antimicrobial irrigation. This article explores the causes of SSIs, such as modifiable and nonmodifiable patient factors and preoperative, intraoperative, and postoperative procedural factors, and discusses some of the specific recommended strategies related to the prevention of SSIs that perioperative nurses can initiate in their workplace.

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Section: Strategies To Prevent Ssismentioning

confidence: 99%

Perioperative Strategies for Surgical Site Infection Prevention

Bashaw¹

2018

AORN Journal

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“…Although reports of longevity have indicated a progressive increase of the life span of ICD devices over the years, from a mean of 19 months in 1980 to 48 months in 2009 to 65 months in 2015, there is still room for improvement, as this is quite an expensive therapy and patient and physician expectations run high for a more satisfactory performance of these devices, a crucial determinant of cost‐efficacy of ICD therapy . Reducing the frequency of generator replacements would also reduce the frequency of important complications, such as device infection, and their consequent costs . Real‐life longevity is definitely sharply shorter compared with the industry‐projected longevity, which has always overestimated ICD device performance …”

Section: Discussionmentioning

confidence: 99%

“…18 Reducing the frequency of generator replacements would also reduce the frequency of important complications, such as device infection, and their consequent costs. [19][20][21] Real-life longevity is definitely sharply shorter compared with the industry-projected longevity, which has always overestimated ICD device performance. 10,16,22 In the present study, contemporary devices performed modestly better in comparison with earlier devices by about 7 months, a finding that is similar to previous reports.…”

Section: Discussionmentioning

confidence: 99%

“Real life” longevity of implantable cardioverter‐defibrillator devices

Manolis¹,

Maounis

Koulouris

et al. 2017

Clinical Cardiology

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Background Manufacturers of implantable cardioverter‐defibrillators (ICDs) promise a 5‐ to 9‐year projected longevity; however, real‐life data indicate otherwise. The aim of the present study was to assess ICD longevity among 685 consecutive patients over the last 20 years. Hypothesis Real‐life longevity of ICDs may differ from that stated by the manufacturers. Methods The study included 601 men and 84 women (mean age, 63.1 ± 13.3 years). The underlying disease was coronary (n = 396) or valvular (n = 15) disease, cardiomyopathy (n = 220), or electrical disease (n = 54). The mean ejection fraction was 35%. Devices were implanted for secondary (n = 562) or primary (n = 123) prevention. Single‐ (n = 292) or dual‐chamber (n = 269) or cardiac resynchronization therapy (CRT) devices (n = 124) were implanted in the abdomen (n = 17) or chest (n = 668). Results Over 20 years, ICD pulse generator replacements were performed in 238 patients (209 men; age 63.7 ± 13.9 years; ejection fraction, 37.7% ± 14.0%) who had an ICD for secondary (n = 210) or primary (n = 28) prevention. The mean ICD longevity was 58.3 ± 18.7 months. In 20 (8.4%) patients, devices exhibited premature battery depletion within 36 months. Most (94%) patients had none, minor, or modest use of ICD therapy. Longevity was longest for single‐chamber devices and shortest for CRT devices. Latest‐generation devices replaced over the second decade lasted longer compared with devices replaced during the first decade. When analyzed by manufacturer, Medtronic devices appeared to have longer longevity by 13 to 18 months. Conclusions ICDs continue to have limited longevity of 4.9 ± 1.6 years, and 8% demonstrate premature battery depletion by 3 years. CRT devices have the shortest longevity (mean, 3.8 years) by 13 to 17 months, compared with other ICD devices. These findings have important implications, particularly in view of the high expense involved with this type of electrical therapy.

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“…Furthermore, device recipients who develop device infection have increased device-dependent, long-term mortality even after successful treatment of infection ( 18 ). The only way to deal with this grisly reality is to take extra measures to prevent or minimize CIED infections by performing a lege artis procedure ( 19 ). Thus, in parallel to the increasing complications, there is a growing need for lead extraction to manage such complications ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

Cardiac implantable electronic device lead extraction using the lead-locking device system: keeping it simple, safe, and inexpensive with mechanical tools and local anesthesia

Manolis

Georgiopoulos²,

Metaxa³

et al. 2017

Anatol J Cardiol

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Objective:We have previously reported our successful approach for percutaneous cardiac implantable electronic device (CIED) lead extraction using inexpensive tools, which we have continued over the years. Herein we report the results of the systematic use of a unique stylet, the lead-locking device (LLD), which securely locks the entire lead lumen, aided with non-powered telescoping sheaths in 54 patients to extract 98 CIED leads.Methods:This prospective observational clinical study included 38 men and 16 women aged 68.9±13.1 years undergoing lead extraction for device infection (n=46), lead malfunction (n=5), or prior to defibrillator implant (n=3). Leads were in place for 6.7±4.3 years. Infections were more commonly due to Staphylococcus species (n=40). There were 78 pacing (31 ventricular, 37 atrial, 4 VDD, and 6 coronary sinus leads) and 20 defibrillating leads.Results:Using simple traction (6 leads) and the LLD stylets (92 leads) aided with telescoping sheaths (15 patients), 96 (98%) leads in 52 (96.3%) patients were successfully removed, with all but one leads removed using a subclavian approach; in 1 patient, the right femoral approach was also required. In 2 patients, distal fragments from one ventricular pacing and one defibrillating lead could not be removed. Finally, lead removal was completely (52/54) (96.3%) or partially (2/54) (3.7%) successful in 54 patients for 96 of 98 leads (98%) without major complications.Conclusion:Percutaneous lead extraction can be successful with mechanical tools using the LLD locking stylet aided with non-powered telescoping sheaths through a simplified, safe, and inexpensive procedure using local anesthesia alone.

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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

Abstract: 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.

Cited by 16 publications

References 33 publications

Perioperative Strategies for Surgical Site Infection Prevention

Perioperative Strategies for Surgical Site Infection Prevention

“Real life” longevity of implantable cardioverter‐defibrillator devices

Cardiac implantable electronic device lead extraction using the lead-locking device system: keeping it simple, safe, and inexpensive with mechanical tools and local anesthesia

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