Showering with the Driveline Exit Site Exposed to Well Water Does Not Increase Rates of Driveline Exit Site Infection

Abstract

Purpose Determine the effects of showering on rates of driveline exit site infections (DLESI). Methods Prospective analysis of all durable left ventricular assist device (LVAD) patient implants at a single academic center from June 2011 to June 2018. All patients who were provided instructions for showering were included in this analysis (n=164). Exclusion criteria included patients that expired before 90 days of support and those not discharged prior to transplant (n=30). Patients were instructed to shower without a dressing covering their DLES, to use antibacterial soap and then immediately apply a sterile dressing using a standard kit of supplies. Infections were diagnosed with positive exit site cultures. Self-reported household water sources, well water vs municipal water, were used to compare the rates of DLESI. Our overall DLESI infection rates were compared to STS INTERMACS data. SPSS was used to analyze statistics. Results Overall at our center, 77% of the patients were free of DLESI. Demographics, duration of support, indication for LVAD and payer source for the well water and municipal water groups were similar except the well water group was older (p=0.003). Freedom from DLESI was 83% (n=38/46) & 74% (n=65/88) of patients who showered with well & municipal water respectively (p=0.254). Kaplan Meier curves are similar (p=0.151). The mean time to DLESI is 90 days and 87 days in the well and municipal water groups respectively (p=0.153). The late phase infection rate (after the first three months) per 100 pt months at our center is 1.16 compared to STS INTERMACS at 1.38. Conclusion At a single center, LVAD patients showering with different water sources have comparable rates of freedom from DLESIs. LVAD patients who follow a DLES management protocol that includes showering have comparable rates of DLESI when compared to STS INTERMACS data.