Advertisement
Major Article| Volume 48, ISSUE 7, P786-790, July 2020

Download started.

Ok

Variability in practice patterns regarding protective isolation measures after heart transplantation: A secondary analysis of the international BRIGHT study

Published:January 13, 2020DOI:https://doi.org/10.1016/j.ajic.2019.11.012

      Background

      Infection control is a cornerstone of post-heart transplantation (HTx) in-hospital management when immunosuppression is highest. The use of protective isolation persists despite its questionable effectiveness. We describe and compare practice patterns internationally and assessed correlates of protective isolation.

      Methods

      Using the BRIGHT-study data, a cross-sectional intercontinental study, we assessed 12 protective isolation measures in 4 continents, 11 countries, and 36 HTx centers. Data were summarized descriptively, as appropriate. Comparisons between countries and continents and association testing between center characteristics and number of isolation measures used were also explored by general linear modeling.

      Results

      A total of 89% (32/36) of HTx centers used protective isolation measures with an average of 4.5 protective isolation measures per center (SD, 2.6; range 1-10). Most often applied were disinfecting high-touch surfaces (n = 27/34; 79.4%), use of private room (n = 27/36; 75.0%), and changing linen daily (n = 25/36; 69.4%). Least applied were wearing a cap (n = 6/35; 17.1%) and high-efficiency particulate air filtration (N = 5/32; 15.6 %). Larger centers and those with dedicated beds for HTx applied more isolation measures.

      Conclusions

      Protective isolation measures are still widely applied within heart transplant centers across the world persists notwithstanding its doubtful effectiveness. Future clinical guidelines for heart transplant management should include a statement of the need for strict adherence to standard infection prevention measures.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Ljungman P Snydman D Boeckh M Transplant infections. 4th ed. Springer, Basel (Switzerland)2016: 101-112 (151-184, 823-843)
        • Kush KK
        • Cherikh WS
        • Chambers DC
        • Goldfarb S
        • Hayes Jr., D
        • Kucheryavaya AY
        • et al.
        The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-fifth adult heart transplantation report-2018; focus theme: multiorgan transplantation.
        J Heart Lung Transplant. 2018; 37: 1155-1168
        • Mangini S
        • Alves BR
        • Silvestre OM
        • Pires PV
        • Pires LJ
        • Curiati MN
        • et al.
        Heart transplantation: review.
        Einstein. 2015; 13: 310-318
      2. Centers for Disease Control and Prevention. Standard precautions for all patient care. Available from: https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html. Accessed November 11, 2019.

        • Boaz MR
        • Bordignon S
        • Nesralla IA
        The importance of preventive measures in the prophylaxis of infections in patients submitted to heart transplant during the first thirty postoperative days.
        Braz J Cardiovasc Surg. 2006; 21: 188-193
        • Costanzo MR
        • Dipchand A
        • Starling R
        • Anderson A
        • Chan M
        • Desai S
        • et al.
        International Society of Heart and Lung Transplantation. The ISHLT Guidelines for the care of heart transplant recipients.
        J Heart Lung Transplant. 2010; 29: 914-956
        • Walsh TR
        • Guttendorf J
        • Dummer S
        • Hardesty RL
        • Armitage JM
        • Kormos RL
        • et al.
        The value of protective isolation procedures in cardiac allograft recipients.
        Ann Thorac Surg. 1989; 47: 539-545
        • Gamberg P
        • Miller JL
        • Lough ME
        Impact of protective isolation on the incidence of infection after heart transplantation.
        J Heart Transplant. 1987; 6: 147-149
        • Berben L
        • Denhaerynck K
        • Dobbels F
        • Engberg S
        • Vanhaecke J
        • Crespo-Leiro MG
        • et al.
        Building research initiative group: chronic illness management and adherence in transplantation (BRIGHT) study: study protocol.
        J Adv Nurs. 2015; 71: 642-654
        • Stehlik J
        • Edwards LB
        • Kucheryavaya AY
        • Aurora P
        • Christie JD
        • Kirk R
        • et al.
        The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult heart transplant report–2010.
        J Heart Lung Transplant. 2010; 29: 1089-1103
        • Boraz RA
        • Myers R
        A national survey of dental protocols for the patient with a cardiac transplant.
        Spec Care Dentist. 1990; 10: 26-29
        • Danzinger-Isakov LA
        • Faro A
        • Sweet S
        • Michaels MG
        • Aurora P
        • Mogayzel Jr., PJ
        • et al.
        Variability in standard care for cytomegalovirus prevention and detection in pediatric lung transplantation: survey of eight pediatric lung transplant programs.
        Pediatr Transplant. 2003; 7: 469-473
        • Ison MG
        • Stosor V
        Transplantation of high-risk donor organs: a survey of US solid organ transplant center practices as reported by transplant infectious diseases physicians.
        Clin Transplant. 2009; 23: 866-873
        • Grol R
        • Wensing M
        • Eccles M
        • Davis D
        Improving patient care: the implementation of change in health care.
        2nd ed. John Wiley & Sons, Hoboken (NJ)2013
        • De Geest S
        • Kesteloot K
        • Degryse I
        • Vanhaecke J
        Hospital costs of protective isolation procedures in heart transplant recipients.
        J Heart Lung Transplant. 1995; 14: 544-554