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Reducing Infection In Interventional Cardiology Procedures

Infections following interventional cardiology procedures are very low but if patients are affected, complications can be life threatening.

Not only do patients suffer through prolonged treatment and longer hospital stays, but the cost to hospitals is also considerable. At the General Hospital of Ioannina in Greece Dr Dimitrios Nikas, has pioneered the use of InteguSeal* microbial sealant to ensure the risk of infection in his unit is minimized.

With a baseline infection rate estimated to be just 0.2 to 0.3% in percutaneous coronary interventions (1), additional procedures over and above the standard processes for the

sterilisation of puncture sites are not always considered necessary. However when a patient started to have fever two days after a percutaneous intervention, the resulting implications for the patient and the hospital caused a radical review of the puncture site preparation.

dr-nikasOn examining the patient further, he was found to have an Osler node on the big toe and septic emboli on the sole of his foot. Further investigation with CT-angiography showed that the patient had three mycotic aneurysms located on the common iliac, external iliac and common femoral artery. They were the source of the emboli.

The patient was suffering from severe complications triggered by an infection following his PCI. He stayed in hospital for approximately six months, had two further serious surgical interventions and was treated with the latest high tech antibiotics which, themselves resulted in a series of secondary complications. The cost to the hospital was estimated at 200,000 Euros.

“This is thankfully a rare but nevertheless serious event,” explained Dr Dimitrios Nikas, Consultant Interventional Cardiologist in the Department of Cardiology. “It made us look for methods to optimize our puncture site sterilization.”

Researching the issue, Dr Nikas, who performs around 300 percutaneous procedures every year, found an article by Towfigh el al (2) detailing a reduction in incidence of wound

contamination by skin flora and the findings of Private Docent Dr Pascal Dohmen (3) which showed a fall in the rate of surgical site infections in cardiothoracic surgery at the Charité Hospital in Berlin, Germany. Both studies had evaluated InteguSeal* microbial sealant.

InteguSeal* is a product of Kimberly-Clark Healthcare and is a single-use, sterile, cyanoacrylate-based film-forming liquid that binds to the proteins and water in the skin to form a microbial barrier designed to prevent intraoperative contamination of surgical incisions from skin flora while allowing normal transpiration of water vapor. Provided in a ready-to-use applicator, InteguSeal* is intended to be applied on the skin over commonly used surgical skin preparation products prior to a surgical incision. Upon polymerization InteguSeal bonds to the skin and immobilizes the bacteria which survive the application of antimicrobial surgical skin preparation products.

Dr Nikas performs both cardiac and peripheral percutaneous interventions, including carotid, renal and coronary interventions . For the coronary interventions he prefers the radial access whilst for the peripheral interventions he mainly uses a femoral access. Dr Nikas said: “We looked at early skin contamination (after disinfection), late skin contamination, acute bacteremia, late bacteremia and we cultured the tip of the introducer sheaths that remained in the groin for more than six hours.

“One of the things that struck us was the fact that the after skin preparation, 4.8% of patients still had skin contamination with Staphylococus Aureus and in that same group 50% of the sheaths that remained in the groin for six hours or more were positive for Staphylococus Aureus.

“Our study allowed us to conclude that the use of InteguSeal* reduces significantly the rates of late skin contamination.”

As a result, procedures have changed in the Department of Cardiology. “We used to leave the introducer sheath in after difficult, usually coronary, procedures,” explained Dr Nikas. “For example where the patient lost a side branch during the procedure or when the patient had chest pain after the procedure, in other words, unstable patients. This allows us to have quick access in case of urgent repeat catheterization. Now, we stopped leaving introducer sheaths. They are removed at the end of the procedure and we use InteguSeal* for every single interventional procedure.”

Dr Nikas believes that infection prevention will become more of a focus now that interventional cardiology procedures are becoming more and more invasive with more foreign materials implanted into the patient ranging from wound closure devices to percutaneous valves and aortic endografts. He believes that the use of InteguSeal* is justified, when using catheters with long introducer sheaths, central venous lines, port access catheters, pacemakers, dialysis catheters and other invasive procedures,  as  it will minimize the risk of serious infectious complications.

Dr Dimitrios Nikas presented his findings in Europe in an abstract entitled “Effectiveness of new microbial sealant in reducing bacteremia along with puncture site and sheath contamination after percutaneous interventions” at EuroPCR 2010 in Paris in May 2010 and the MEET Congress in Marseille in June 2010.


  1. Staphylococcus aureus infection complicating percutaneous coronary interventions; van Werkum JW, ten Berg JM, Thijs Plokker HW, Kelder JC, Suttorp MJ, Rensing BJ, Tersmette M.; Int J Cardiol. 2008 Aug 18;128(2):201-6. Epub 2007 Jul 30
  2. Significant Reduction in Incidence of Wound Contamination by Skin Flora Through Use of Microbial Sealant. Shirin Towfigh; William G. Cheadle; Stephen F. Lowry; Mark A. Malangoni; Samuel E. Wilson Arch Surg. 2008;143(9):885-891
  3. Reduction in surgical site infection inpatients with microbial sealant prior to coronary artery bypass graft surgery and graft surgery – a case-control study. P.M. Dohmen, D. Gabbieri, A, Weymann, J. Linneweber, W. Konertz. Journal of Hospital Infection, February 2009

Published on: September 20, 2010

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