Substantial Reduction in Driveline Infection Rates With the Modification of Driveline Dressing Protocol

Area of Science:

• Cardiology
• Medical Devices
• Infectious Disease Prevention

Background:

• Driveline infection (DLI) is a significant complication in patients with continuous-flow left ventricular assist devices (CF-LVADs), leading to morbidity and mortality.
• Current percutaneous site care techniques may not be optimal for preventing DLIs.

Purpose of the Study:

• To evaluate the effectiveness of an alternate driveline dressing protocol in reducing the incidence of DLIs in CF-LVAD patients.
• To compare DLI rates between patients managed with a standard protocol versus a new protocol.

Main Methods:

• A retrospective review of 153 CF-LVAD patients implanted between January 2010 and October 2015.
• Patients were divided into two groups based on the implementation date of a new driveline dressing protocol (September 1, 2012).
• Follow-up was conducted for 2 years to assess freedom from DLI.

Main Results:

• The new dressing protocol group (group 2) showed a significantly higher freedom from DLI at 24 months (89%) compared to the standard protocol group (group 1) (53%; P = .01).
• Patients in group 1 had a 3.18 times greater risk of DLI compared to group 2 (incident rate ratio 3.18, 95% CI 1.23-8.18; P = .016).
• The new protocol group also had a higher proportion of HVAD implants, which may influence DLI risk.

Conclusions:

• A new driveline dressing protocol dramatically improved freedom from DLI at 2 years in CF-LVAD patients.
• Alternate percutaneous site care techniques are effective in reducing DLI rates in this patient population.