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Abstract: FR-OR093

Targeting Zero Infection in Hemodialysis Patients: An Experience of an Intra-Hospital Hemodialysis Unit with None Catheter-Related Bloodstream Infection in 633 Days

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Luders, Claudio, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
  • Lobo, Renata Desordi, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
  • Ventura, Carlucci Gualberto, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
  • Roque, Felicio, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
  • Di nizo, Fabio Eduardo reis, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
Background

Patients undergoing hemodialysis (HD) through tunnelled central venous catheter are exposed to several risks, including infection and trombosis. Catheter-related bloodstream infection (CR-BSI) is the second major cause of death in this population. To reduce the incidence of CR-BSI we conducted an intervention study aimed in lowering these rates.

Methods

An quasi-experimental, pre-post intervention study was conducted in an intra-hospital hemodialysis unit with 15 HD machines and attending 70 patients. In 2011, we implemented an evidence-based intervention package aiming at elimination of all preventable CR-BSI, including the following measures: 1. Alcohol based gel delivery system fixed in every HD machine for hand hygiene 2.Catheter external cleaning with alcoholic chlorhexidine before manipulation for at least 1 minute 3.A scrub-the-hub protocol with strictly aseptic technic for catheter manipulation in any intervention 4.Use of chlorhexidine-impregnated dressing 5.Training all nurse staff admitted, annual re-training and evaluation of performance with infection rate feedback 6. The use of citrate 30% as lock solution.

Results

During the follow-up period (January 2011 to January 2018) a mean of 34 patients (range 30-38) used tunnelled catheter as vascular access each year. The median age was 72 years (range 20-90 years), and 35% of patients were diabetic. After implementation of the intervention package, we observed a continuous reduction in the CR-BSI rate: from 1.1/1000 catheter-days in 2010, the year before the intervention measures; to 0.6/1000, 0.6/1000, 0.1/1000, 0.1/1000, 0.2/1000, 0.2/1000 and 0.0/1000 catheter-days from 2011 to 2017, respectively. Between April 2016 and January 2018, we reached the longest period without CR-BSI events: 633 days, interrupted by a Serratia marcenses CR-BSI with tunnel infection in a recipient of pancreas transplant.

Conclusion

Implementation of several evidence-based practices and continuous education can reduce CR-BSI in HD patients to a very low and sustained level. Targeting zero infection proposing eliminate all preventable infection should be routine practice of all dialysis units.