A Care Pathway Approach to Reduce Driveline Infections: Compliance and Outcomes

Purpose Among patients on ventricular assist device (VAD) support, driveline infections (DLIs) are among the most common adverse event. DLIs have an impact on the patient and healthcare system and therefore efforts to prevent and decrease DLIs are essential. Methods This quality improvement project used a 3-pronged care-pathway (CP) in patients implanted from 08/18-07/19. The CP included: intra-operative standardization (pre- and post-implant prophylaxis antibiotics, velour positioning, internal suture use and skin closure of the DL); post-operative standardization (use of a DL dressing program, dietitian and social work counselling); and pre-discharge initiatives (patient/caregiver teaching, development of a new video, quiz and patient infographic). Compliance with the CP was noted in the patient's chart. A compliance score out of 17 points was calculated for each patient, with good compliance to the CP considered a score ≥80%. The association between development of DLIs and compliance was analyzed. Results There were 21 patients in the CP. No patients in the CP developed a DLI during their index hospital stay, 11 (52%) developed a DLI in the first year post implant, and six (55%) patients were readmitted to the hospital for treatment. 62% of the patients had a compliance score of ≥ 80%, with the median compliance score being 65% (IQR 27, 94). No association was seen between good compliance and development of a DLI within one-year post implant (p=0.60) or readmission (p=0.25). As the figure highlights there was a noticeable decrease in compliance over time, with the last two quarters of the project having the worst compliance scores and the majority of DLIs (66%). Conclusion Although compliance was not associated with DLI, the majority of infections occurred later in the experience when compliance scores where much lower. Given the decrease in compliance over time, an assessment of influencing situational factors is needed. Further, awareness-raising and additional training on the CP initiatives may improve outcomes.