CIED Infection Quality Initiative Demonstration Project (RECTIFY)
The Review and Improvement of Cardiac Implantable Device Infection Quality Initiative (RECTIFY) Demonstration Project
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Kimberly Ward, MPH
- Phone Number: 9196606409
- Email: kimberly.t.ward@duke.edu
Study Contact Backup
- Name: Sarah Brady
- Phone Number: 9196818928
- Email: sarah.brady@duke.edu
Study Locations
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Illinois
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Chicago, Illinois, United States, 60611
- Recruiting
- Northwestern
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Contact:
- Anna Huskin, RN, BSN
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Principal Investigator:
- Albert Lin, MD
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North Carolina
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Charlotte, North Carolina, United States, 28203
- Not yet recruiting
- Atrium Health
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Principal Investigator:
- Rohit Mehta, MD
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Contact:
- Melissa Myers
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Contact:
- Nicole Boisvert
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Principal Investigator:
- Satish Misra, MD
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Greensboro, North Carolina, United States, 27401
- Not yet recruiting
- Moses Cone
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Contact:
- Cameron Lambert, MD
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Principal Investigator:
- Cameron Lambert, MD
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥18 years
- Cardiovascular Implantable Electronic Device (CIED) in place
Presumed CIED infection, as defined by:
- Positive blood culture (two or more positive blood cultures for typical skin organisms (coagulase-negative staphylococci, Corynebacterium species, Propionobacterium species), or one positive blood culture for all other microorganisms), with no other source identified to explain the bacteremia
- Cases with definite evidence of pocket infection (defined as localized erythema, swelling, pain, tenderness, warmth, erosion, or drainage), if treated with antibiotics before culture, even with negative culture, will be considered device infection
Exclusion Criteria:
- Patients who are inappropriate for device extraction, for example those who are DNAR and not using therapy to prolong survival because any procedure is considered inappropriate and/or it is unlikely that extraction would change overall prognosis
- Death within one week of definitive CIED systemic infection diagnosis or positive blood culture. Cases of bacteremia originating from a source other than the CIED that resolve without any evidence of CIED involvement should not be considered as CIED infection
- Patients with left ventricular assist devices (LVADs)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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Other: Quality Improvement Program
The quality improvement program will consist of development and/or refinement of participating health system's patient care pathways tailored to address the gaps and barriers around recognition and treatment of CIED infections.
Interventions will be customized and modified as needed based on regular reviews and implementation progress.
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Multidisciplinary team will be established that will define gaps in care, monitor ongoing data, identify barriers to guideline-directed care, and develop and implement multifaceted intervention to address the barriers
An outreach visit consulting group from the coordinating center and trial leadership will provide external guidance on reviewing data, defining barriers, and implementing interventions
These interventions are not limited to targeted engagement with non-extractors, electronic health record (EHR) decision support, creation of OR block time, use of opinion leaders, and development of clinical pathways.
In addition, once patients are identified and referred to extraction centers, clinical pathways are needed to provide prompt care without clinical delay
The coordinating center will provide ongoing feedback related to the site's data.
This will include time to diagnosis, treatment, and outcomes related to the device infection.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Proportion of patients with CIEDs and positive blood cultures who receive extraction (per guidelines)
Time Frame: Up to 12 months
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Proportion of patients with CIEDs and positive blood cultures, who receive extraction
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Up to 12 months
|
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Proportion of patients with CIEDs and definite pocket infections who receive extraction (per guidelines)
Time Frame: Up to 12 months
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Proportion of patients with CIEDs and probable device infection, who receive extraction
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Up to 12 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Proportion of patients with extraction within 7 days of diagnosis
Time Frame: Up to 12 months
|
Proportion of patients who who receive extraction within 7 days and during index hospitalization
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Up to 12 months
|
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Proportion of patients with extraction during index hospitalization
Time Frame: Up to 12 months
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Up to 12 months
|
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Time from positive blood culture/clear pocket infection to extraction for those undergoing extraction
Time Frame: Up to 12 months
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Up to 12 months
|
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Number of patients identified with suspected CIED infection
Time Frame: Up to 12 months
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Up to 12 months
|
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Number of patients referred to both Extraction Center (from outside hospital) and electrophysiologists (at Extraction Center) for extraction
Time Frame: Up to 12 months
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Up to 12 months
|
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Number of actual extractions
Time Frame: Up to 12 months
|
Up to 12 months
|
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Number of patients with multi-organ failure or septic shock at time of extraction
Time Frame: Up to 12 months
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Up to 12 months
|
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Estimated healthcare utilization/costs
Time Frame: Up to 12 months
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Up to 12 months
|
|
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Staff satisfaction as measured by a qualitative survey
Time Frame: Up to 12 months
|
Up to 12 months
|
|
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Patient satisfaction as measured by a qualitative survey
Time Frame: Up to 12 months
|
Up to 12 months
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Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Mortality
Time Frame: Up to 12 months
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Number of deaths from CIED infection
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Up to 12 months
|
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Length of stay
Time Frame: Up to 12 months
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Clinical outcomes: number of days of hospitalization
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Up to 12 months
|
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Days of antibiotic treatments
Time Frame: Up to 12 months
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Number of days patient received antibiotics
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Up to 12 months
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Chris Granger, MD, Duke Clinical Research Institute
- Principal Investigator: Sean Pokorney, MD, Duke Clinical Research Institute
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- Pro00110118
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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