Abstract: TH-PO909

Sustained Low Central Venous Catheter-Related Bloodstream Infection Rates in HD Patients with an Antibiotic Lock over a 3-Year Period

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

  • Sun, Sumi J., Satellite Healthcare, San Jose, California, United States
  • Gomez, Norma, Satellite Healthcare, San Jose, California, United States
  • Yang, Fang, Satellite Healthcare, San Jose, California, United States
  • Abra, Graham E., Satellite Healthcare, San Jose, California, United States
  • Schiller, Brigitte, Satellite Healthcare, San Jose, California, United States
Background

CVCs are associated with catheter-related bloodstream infection (BSI) resulting in increased morbidity and mortality. Following our report of significantly reduced infection when 320 µg/mL gentamicin in 4% citrate is used as the CVC locking solution (Moran AJKD 2012), this has remained the standard of care in patients dialyzing with a CVC, unless physician order requested otherwise. The infection rates were monitored through an internal QC program developed for National Healthcare Safety Network (NHSN) reporting.

Methods

This study evaluated NHSN data with self-reported infection rates from January 2014 to December 2016 in a non-profit dialysis provider with a total of 57 free-standing dialysis facilities serving more than 5000 HD patients. BSI was reported according to NHSN criteria. Data were audited through comparison to an internal infection control report and discrepancies reconciled prior to final NHSN submission. Blood cultures were mandated before any antibiotic administration for suspected BSI, and 85% or more are sent to one internal lab (Ascend).

Results

The rate of catheter-related bloodstream infection over the three years was 1.00 episodes/100 patient months, 54% lower than the national average of 2.16 for CVC-related BSI (2014 NHSN BSI Pooled Mean Rate/100 patient-months). Monthly BSI rates showed minor fluctuations, however none exceeded the national average in any given month.

Conclusion

Gentamicin 320 µg/mL in 4% sodium citrate as a routine catheter lock demonstrated sustained low CVC-related BSI rates in HD patients, with approximately half the infection rate compared with the national average. Gentamicin-citrate lock should be considered the standard of care in patients with CVC access.

Figure 1: Monthly Bloodstream Infection Rates for Patients with Any CVC Access from 01/2014 to 12/2016