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Infection Control and Prevention Practices
in Centers Performing Mechanical Circulatory Support Operations

CALLING ALL VAD CENTERS!!



Infection is a common complication associated with significant morbidity and mortality after implantation of mechanical circulatory support (MCS) devices. In recent years more centers have been involved in placement of these devices as a bridge to transplantation or as a bridge to recovery. At the same time the population who get these devices for destination therapy is expanding. We would like to find out what are the current routine infection-control and prevention protocols that centers around the world are using in MCS patients.

Infections are common in MCS device recipients (up to 80% in reported series) and carry high morbidity and mortality. Infection specific to the device like drive-line infections may extend and spread to deeper structures and become impossible to eradicate due to alterations of the immunity in the MCS recipient or formation of bio-film by some of the organisms involved. These infections may be potentially prevented by following strict infection control and prevention rules.

Over the years there has been increase in infection secondary to resistant organisms. Examples include Methicillin Resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus (VRE), Extended-spectrum Beta-lactamase (ESBL) producing organisms, and Candida species resistant to fluconazole. At the same time the availability of new antimicrobial agents has become very limited. Therefore, prevention practices are crucial in an effort to reduce infection. Nevertheless, there are no guidelines for clinicians regarding usage of infection control and prevention methods and each center is using its own internal protocol.

The ISHLT has contacted centers that are involved in implantation of these devices:130 centers have agreed to participate and complete a questionnaire developed by Dr. Shimon Kusne and colleagues. The information obtained through this questionnaire will serve as a basis for construction of consensus in this patient population and possibly could help in designing future infection control and prevention multi-center trials to study what is best practice protocol for infection prevention of MCS recipients. Thank you if you have responded.

If you have not yet responded and would like someone from your center to participate in this questionnaire, please notify Shimon Kusne (Kusne.Shimon@mayo.edu) as soon as possible.