Adherent skin barrier drape use is associated with a reduced risk of cardiac implantable device infection: Results from a prospective study of 14,225 procedures

Mehrdad Golian; Nicolas M Berbenetz; Roupen Odabashian; Mouhannad M Sadek; Vicente Corrales-Medina; Alper Aydin; Darryl R Davis; Martin S Green; Andres Klein; Girish M Nair; Pablo B Nery; F Daniel Ramirez; Calum Redpath; Simon P Hansom; David H Birnie

doi:10.1016/j.hroo.2023.12.002

Adherent skin barrier drape use is associated with a reduced risk of cardiac implantable device infection: Results from a prospective study of 14,225 procedures

Heart Rhythm O2. 2023 Dec 15;5(2):103-112. doi: 10.1016/j.hroo.2023.12.002. eCollection 2024 Feb.

Authors

Mehrdad Golian^{1

2}, Nicolas M Berbenetz^{1

2}, Roupen Odabashian^{1

2}, Mouhannad M Sadek^{1

2}, Vicente Corrales-Medina³, Alper Aydin^{1

2}, Darryl R Davis^{1

2}, Martin S Green^{1

2}, Andres Klein^{1

2}, Girish M Nair^{1

2}, Pablo B Nery^{1

2}, F Daniel Ramirez^{1

2}, Calum Redpath^{1

2}, Simon P Hansom^{1

2}, David H Birnie^{1

2}

Affiliations

¹ University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
² Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³ Division of Infectious Diseases, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.

Abstract

Background: Cardiac implantable electronic device (CIED) infection is a costly and highly morbid complication. Perioperative interventions, including the use of antibiotic pouches and intensified perioperative antibiotic regimens, have demonstrated marginal efficacy at reducing CIED infection. Additional research is needed to identify additional interventions to reduce infection risk.

Objective: We sought to evaluate whether adherent skin barrier drape use is associated with a reduction in CIED infection.

Methods: A prospective registry of all CIED implantation procedures was established at our institution in January 2007. The registry was established in collaboration with our hospital infection prevention team with a specific focus on prospectively identifying all potential CIED infections. All potential CIED infections were independently adjudicated by 2 physicians blinded to the use of an adherent skin barrier drape.

Results: Over a 13-year period, 14,225 procedures were completed (mean age 72 ± 14 years; female 4,918 (35%); new implants 10,005 (70%); pulse generator changes 2585 (18%); upgrades 1635 (11%). Of those, 2469 procedures (17.4%) were performed using an adherent skin barrier drape. There were 103 adjudicated device infections (0.73%). The infection rate in patients in the barrier use groups was 8 of 2469 (0.32%) as compared with 95 of 11,756 (0.8%) in the nonuse group (P = .0084). In multivariable analysis, the use of an adherent skin barrier drape was independently associated with a reduction in infection (odds ratio 0.32; 95% confidence interval 0.154-0.665; P = .002).

Conclusion: The use of an adherent skin barrier drape at the time of cardiac device surgery is associated with a lower risk of subsequent infection.

Keywords: Antibiotics; Cardiac implantable electronic device; Complication; Device upgrade; Implantable cardioverter-defibrillator; Infection; Pacemaker; Pulse generator change.