Becker's Clinical Quality & Infection Control

19 Executive Briefing: Cardiovascular Implantable Electronic Device Infections Sponsored by: A s hospitals and healthcare providers continue to strive to reduce healthcare-associated infections, they have been successful in several areas, like in reducing central line- associated bloodstream infections and in some surgical site infec- tions. However, one type of SSI has persisted and actually is on the rise: Cardiovascular Implantable Electronic Device Infections. In fact, the increase in admissions for CIED infections is five-fold the increase in CIED implantations, according to data published in Pacing and Clinical Electrophysiology and the Journal of the American College of Cardiology. "The rates have been steadily increasing…and we're seeing more infections and more serious infections" despite the best efforts of physicians, says Ibrahim Hanna, MD, the medical di- rector of cardiac electrophysiology with Baptist Health Centers in Birmingham, Ala. There are a few possible reasons for the recent increase in CIED Infections. One is because physicians are treating older patients who have more comorbidities. Since people are living longer, they are more likely to need a pacemaker, or defibrillator, and as a result, are more likely at a later time to have their device revised, replaced or upgraded. One tool that helps measure the risk of a given patient contracting a CIED Infection is by the use of odds ratio's which measure a patient's increased risk of infection if they have certain risk factors. These risk factors can originate from the patient themselves, the medications they take, and/or the proce- dure that a patient is going to have or has even had in the past. An example would be that if a patient has diabetes, which has an odds ratio of 3.5, a diabetic is 3.5 times more likely to get a CIED Infection than a patient who does not have diabetes. Another ex- ample would be that if a patient has renal failure, which has an odds ratio of 11.97, so the patient is 11.97 times more likely to get a CIED Infection than a patient who does not have renal failure. Common risk factors for CIED Infection include early reinterven- tion, history of previous infection, having congestive heart failure, and the use of corticosteriods. "I've had patients in the last five to 10 years who are living longer and I'm doing more and more device change-outs, and those specifically have much higher infection rates than a new implant," explains Christopher Ellis, MD, the director of cardi- ac electrophysiology at Vanderbilt University Medical Center in Nashville, Tenn. Additionally, Dr. Hanna at Baptist notes the increase in antibiotic resistance has made preventing such infections more difficult and made the infections themselves more difficult to treat. No matter the reason, the rising Infection trend is troubling, as CIED Infections can cost nearly $100,000 to treat: CMS estimates that the average cost of a single CIED infection in the U.S. is $72,485. "The big question in the near future is who is going to pay for that," Dr. Ellis notes, as hospitals are being penalized for having high infection rates and becoming more and more responsible for pay- ing the cost of those infections themselves. And, as Dr. Hanna points out, the effects of CIED Infections range far beyond money. "It's not just healthcare economics. It's about the patient's quality of life and mortality." CIED Infections can be debilitating or deadly to the patients they affect. A study in PACE shows patients with a CIED Infection, when compared to device recipients without an infection, had in- creased mortality persisting for three years, even after successful treatment of the infection. The rate of mortality is around 50 per- cent depending on the device, the study found. Therefore, pre- venting CIED Infections is not just a matter of cost — it can be the difference between life and death. What can be done? As with all surgery-related infections, steps can be taken to prevent CIED Infection occurrence. "Strategies to reduce perioperative in- fections can significantly improve outcomes," says George Thom- as, MD, an electrophysiologist with Weill Cornell Medical Center. Dr. Hanna notes that his practice's goal is to reduce infections down to zero, and he and his colleagues have taken several approaches to reduce instances of CIED Infections. One tool he has added to his arsenal is the TYRX™ Absorbable Antibacterial Envelope. How to Quell the Rising Trend of CIED Infections Preventing CIED Infections is not just a matter of cost — it can be the difference between life and death.

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