International Practices for Driveline Exit Site Care and Infection Prevention in Ventricular Assist Devices

Abstract

Purpose Despite the high prevalence of driveline (DL) exit site infections, there is a lack of evidence-based practice guidelines for overall DL exit site care and infection prevention. This study aimed to explore current international practices for DL exit site care and preventing infection. Methods Members (n=248) of the International Consortium of Circulatory Assist Clinicians were asked to complete a self-administered online survey. The survey consisted of 37 items using multiple choice and “select all that apply” answers, delineating infection prevention practices and DL exit site care in the inpatient (pre, intra, and post-operative) and outpatient care settings. Respondents were given 30 days to complete the survey. Data were analyzed with descriptive and inferential statistics. Results There were 15 ways to evaluate infection and 25 different combinations of antibiotics administered pre-implant. Initial DL dressing changes reported by most centers (76%) were performed within 48 hours post-implant. Half of respondents reported daily dressing changes on hospitalized patients. Although 34% had no knowledge about their infection data, 66% reported that their two-year DL infection rates ranged from 0 to 20%. We found no significant associations among frequency of dressing changes, use of antibiotics, staff providing education, and infection rates. However, transplant/VAD centers were more likely to have staff dedicated for performing dressing changes for patients (X2 [3, n=23]=14.21, p=0.003). Conclusion This preliminary study showed multiple strategies in infection prevention and care of DL exit sites in the setting of high infection rates. Future studies are needed to address the limitations inherent to the present research design. A large multinational VAD center study is needed to validate our data and explain the mechanism of the effects of preventive and treatment strategies of DL infections. Solid evidence is needed to inform standard of care for DL exit site care and infection control.