Decrease in Driveline Infections with Change in Driveline Management Protocol

Background: Driveline infections (DLI) are a significant cause of morbidity and mortality in ventricular assist device (VAD) recipients. We compared driveline infection (DLI) rate after an institutional change in driveline management protocol. Methods: We retrospectively reviewed records of left VAD recipients at our institution, based on driveline management. Group 1: daily driveline dressing change consisting of chlorhexidine cleansing, sterile 4x4 gauze, and use of an abdominal binder. Group 2: Dressing change every 3 days consisting of chlorhexidine cleansing, non-sterile silver-impregnated foam with overlying clear dressing, and use of a driveline anchor. Follow-up was censored at first DLI, device removal, transplant or death. Additionally, Group 1 patients’ follow-up was censored when the change in protocol occurred. Statistical analysis: Student’s t-test, Fisher’s exact test, Kaplan-Meier curve and log-rank test. Results: DLI occurred in 16% of 88 VAD recipients (Group 1 n=24, Group 2 n=64). The new driveline management protocol resulted in significantly fewer DLI in Group 2 (6.3% vs. 41.7%, p\u3c0.0001) Conclusions: An updated driveline management protocol demonstrated significant reduction in DLI at our institution. Studies evaluating the optimal approach for driveline management are needed in order to develop a standardized regimen aimed at lowering the risk of DLI