AHA: Most Major Post-Op Infections Occur Post-Discharge
And, skin preparation before and during implant procedures reduces the risk of infections
TUESDAY, Nov. 15 (HealthDay News) -- Major infections occur an average of 14.5 days after cardiac surgery, with 51 percent occurring after discharge; and preoperative skin preparation reduces the incidence of cardiac implantable electronic device (CIED) infections, according to two studies presented at the American Heart Association's Scientific Sessions 2011, held from Nov. 12 to 16 in Orlando, Fla.
Michael A. Acker, M.D., from the University of Pennsylvania in Philadelphia, and colleagues investigated the time of occurrence and risk factors for infections within 60 days of undergoing heart surgery in 5,185 patients without preoperative infections. A total of 280 of the 733 infections were major; most commonly pneumonia (2.4 percent of all patients), and also including Clostridium difficile colitis, bloodstream infections, deep incision site infection, and mediastinitis. Major infections occurred a median of 14.5 days post-surgery, and 51 percent of them developed after discharge. Eight percent of patients suffered minor infections, including symptomatic urinary tract infection and superficial incision site infection.
Renee Koeberl, R.N., from the University of Wisconsin School of Medicine and Public Health in Milwaukee, and colleagues investigated the effect of changes in skin preparation prior to and during CIED implantation. Interventions included avoiding antibiotic pocket flushing, preoperative skin washing the night before and morning of the procedure, and dry-time of three-minutes after surgical skin preparation. Thirty CIED infections occurred during the study period, and the infection rate decreased significantly from 1 to 0.24 percent at 12-months post-implantation following interventions (hazard ratio, 4.2).
"Multidisciplinary interventions (avoidance of antibiotic pocket flushing, additional preoperative skin washing, and three-minute dry time after surgical skin preparation) significantly reduce post-CIED infections," the authors write.