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Abstract: SA-PO1096

Reduction in Number of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Dialysis Catheter Related Bloodstream Infections: Role of Nasal Mupirocin and Chlorhexidine Body Wash

Session Information

  • Vascular Access - II
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Koduri, Sreekanth, Changi General Hospital, Singapore, Singapore
  • Chionh, Chang Yin, Changi General Hospital, Singapore, Singapore
Background

Central Venous Catheter-Related Bloodstream Infections (CRBSI) are an important cause of hospital acquired infection associated with morbidity, mortality and cost. Patients undergoing haemodialysis using a catheter are at significant risk for developing CRBSI, especially with Methicillin-resistant Staphylococcus aureus (MRSA), resulting in serious complications. In our 1000-bed regional hospital, the average CRBSI(MRSA) rate was 0.56 per 1,000catheter days. A quality improvement project was initiated with an aim to reduce the rate by 50%.

Methods

Following the formation of a multidisciplinary team, the catheter insertion protocols and catheter care protocols were harmonised throughout the hospital. A decolonization protocol with Mupirocin 2% nasal cream along with Chlorhexidine bodywash for 5days, was initiated prior to dialysis catheter insertion. Monthly data on prescription and delivery of nasal and skin decolonisation protocol was collected. The CRBSI (MRSA) rates were collected monthly by averaging the number of infections per 1000 catheter days.

Results

Analysis of the data from July 17 – November 2018 showed a significant improvement in the CRBSI rates, after the robust implementation of nasal and skin decolonization protocol (>95%). The average CRBSI (MRSA) rate has improved to 0.14 per 1,000 catheter days from a baseline of 0.56 per 1,000 catheter days (Figure 1). Even though the improvement in CRBSI (MRSA) is believed to be due to introduction of the decolonization protocol, the outcome may have been influenced by other interventions.

Conclusion

The causes of CRBSI can be multifactorial and a multidisciplinary approach is required to reduce the infection rates. With nasal and skin decolonization prior to dialysis catheter insertions, the CRBSI rates, especially related to MRSA can be reduced significantly, as shown in our experience.