Exploring a New Frontier: Adapting and Applying NHSN SSI Definitions for Surveillance of LVAD Infections

Abstract

Device infection is a common and severe post-surgical complication associated with left ventricular assist device (LVAD) implantation. The objective of this project was to adapt the National Healthcare Safety Network’s (NHSN) surgical site infection (SSI) definitions to allow tracking of LVAD infections including those related to the chest and drivelines. In 2012, the NHSN’s SSI definitions were adapted through collaborative efforts between infection prevention and the LVAD team. The definition of SSI at the chest site (superficial and deep) followed NHSN criteria. Additional criteria specific to driveline infections were incorporated into the NHSN SSI definitions. Superficial driveline infection was defined as presence of at least 2 symptoms (erythema, purulent drainage, pain/tenderness) OR physician diagnosis. Deep driveline infection was defined as radiographic evidence of fat stranding AND at least one symptom (purulent drainage, pain/tenderness) OR physician diagnosis. LVAD patients were surveilled for infection for one year after implantation. Chi-square for trend analysis was used to evaluate trends in infection rates over the study period. Between 2012 and September 2014 a total of 46 infections were identified out of 303 procedures (rate=15.2/100 procedures). Of the 46, 10 (22%) were chest infections and 36 (78%) were driveline infections. All chest infections were deep or organ space. Deep infections were more common than superficial at the driveline site accounting for 31 (86%) of the total infections. There was no temporal trend in infection rates (p=0.41). Infection trends are useful in identifying areas for improvement in postsurgical wound care protocol and patient education. Adapting and applying NHSN SSI definitions for surveillance of LVAD infections can be helpful in tracking and trending postsurgical infections in this population.