Abstract: TH-PO888

Tunnelled Hemodialysis Catheter Care Practices and Blood Stream Infection Rate in Children: Results from the SCOPE Collaborative

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Marsenic Couloures, Olivera, Yale University, New Haven, Connecticut, United States
  • Rodean, Jonathan, Children's Hospital Association, Overland Park, Kansas, United States
  • Richardson, Troy, Children's Hospital Association, Overland Park, Kansas, United States
  • Warady, Bradley A., The Children's Mercy Hospital, Kansas City, Missouri, United States
  • Neu, Alicia, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Background

The Standardizing Care to Improve Outcomes in Pediatric End-stage renal disease (SCOPE) collaborative seeks to reduce hemodialysis (HD) catheter associated blood stream infections (CA-BSI) by increasing implementation of standardized HD catheter care bundles. We report on HD catheter care practices and HD CA-BSI rates from SCOPE.

Methods

Catheter care practices and HD CA-BSI reported between 6/2013 and 3/2017 are included. Catheter care bundle compliance is monitored across the reporting period on a sample of patients at each center. Compliance with each element in the care bundle is evaluated as is overall compliance, which is scored as “all or none”, ie each element must be performed to be compliant. For catheters with multiple observations compliance is reported as a percent compliance across observations. Only observations prior to the CA-BSI are included for catheters with infections. Results are reported as median and interquartile range (IQR) and compared by CA-BSI status with Wilcoxon Rank Sum tests. Associations between CA-BSI status and categorical characteristics are compared with chi-square tests.

Results


427 catheters in 424 children [median (IQR) age 12.5 years (6,16), M: 54%, F: 46%] at 27 centers were included. 3569 catheter care observations were submitted with median (IQR) 4 (1,12) observations per catheter. 111 CA-BSI from 66 catheters were reported, yielding a rate of 2.0 infections/100 catheter months. Bundle compliance [%, median (IQR)] in catheters with and without CA-BSI and their comparisons are presented in the Table.

Conclusion

Compliance with an HD catheter care bundle was relatively high among SCOPE centers, and the overall CA-BSI rate is low. The low number of CA-BSI limits the ability to detect significant associations between compliance with care practices and CA-BSI. A comparison of CA-BSI rates before and after implementation of care practices is required to evaluate the impact of SCOPE on CA-BSI rates.

Care practiceNo CA-BSICA-BSIP
Dressing/site assessment100 (100,100)100 (90,100)0.068
Connection/entry100 (94.4,100)100 (90,100)0.221
Disconnection100 (100,100)100 (100,100)0.806
Cap care100 (100,100)100 (100,100)0.082
Dressing change and exit site care87.5 (50,100)100 (40,100)0.483
Overall87.5 (57.1,100)75 (33.3,100)0.062