1. Access Site Infections s/p Cardiac Catheterization Procedure Team Members: Michael Jarotkiewicz Eric Grassman, M.D. Fred Leya, M.D. George Simon Jackie Saulters, ACNP CCL Staff

2. Opportunity Statement Access site infections can be a complication s/p cardiac catheterization procedure. This gives us an opportunity to reduce the incidence of access site infections for our cardiac catheterization lab patients Desired Outcome To identify the risk factors associated with To identify the risk factors associated with the cardiac catheterization related access the cardiac catheterization related access site infections and to achieve a groin access site site infections and to achieve a groin access site infection rate of 0.2% or lower infection rate of 0.2% or lower

3. Patients at high-risk for infection: Diabetes Diabetes Obesity Obesity Age Age Immuno-suppression Immuno-suppression Emergency patients Emergency patients Patient groin preparation consisting of shaving hair in Holding Area using a safety razor Betadine scrub and paint of access site in Procedure Room Most Likely Causes for Current Opportunity

4. No national standard for surgical hat or mask requirements for procedure room staff No re-prep of groin site prior to Perclose closure technique Deployment of Vasoseal closure device to achieve hemostasis on patients that had sheath removal in the nursing units Most Likely Causes for Current Opportunity

5. New protocol for groin preparation in the Holding Area developed: Hair to be clipped from groin versus shaved Groin site washed with Hibiclens soap New protocol for groin preparation in the Procedure Room developed: Duraprep scrub solution versus betadine scrub used to prep groin in the CCL. Duraprep stays on the skin for 72 hours maintaining anti-bacterial effects Solutions Implemented

6. Implemented requirements to wear surgical hat and mask for procedure room staff Infection control in-service provided to the CCL staff for heightened sterile process awareness Antibiotics for high-risk patients determined by the Cardiology attending/fellow Manual hold versus deployment of Vasoseal closure device to achieve hemostasis on patients that had sheath removal in the nursing units Retrospective observational case control study was completed identifying risk factors for infections after cardiac catheterization Solutions Implemented

7. We noticed a decrease in our percentage of access site infections s/p cardiac catheterization lab procedures which has remained at 0.0% from October, 2002 through April 2003 due to: A change in access site preparation techniques A change in access site preparation techniques Re-prep of access site immediately prior to Perclose deployment Re-prep of access site immediately prior to Perclose deployment The identification of high risk patients and subsequent administration of antibiotic agents The identification of high risk patients and subsequent administration of antibiotic agents Data Analysis and Results

8. Results

9. Monthly review and discussion of data from our cardiac catheterization patients for access site infections. Next Steps