Abstract: SA-PO1093
Reducing Early Catheter-Related Bloodstream Infection in Hemodialysis Patients
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
- Koh, Timothy Jee Kam, Tan Tock Seng Hospital, Singapore, Singapore
- Khoo, Benjamin Zhi En, Tan Tock Seng Hospital, Singapore, Singapore
- Ningombam, Sanamatum, Tan Tock Seng Hospital, Singapore, Singapore
- Yeo, See Cheng, Tan Tock Seng Hospital, Singapore, Singapore
Background
Dialysis catheter-related blood stream infection (CRBSI) is a leading complication in hemodialysis (HD) patients, and is associated with increased risk of mortality, invasive procedures, extra hospitalization and/or increase in length of stay. Poor tunneled dialysis catheter (TDC) care by patient, inadequate skin preparation before TDC insertion and lack of prophylactic antibiotics during TDC insertion may contribute to early CRBSI. We examined the role of bundled interventions to reduce early CRBSI in HD patients with newly inserted TDC.
Methods
Between April to September 2017, we instituted a bundle of measures to reduce CRBSI in patients from two designated wards (intervention group); patients in other wards received usual care (control group). In the intervention group, daily chlorhexidine bath was administered for all patients prior to TDC insertion and nasal decolonization was performed for methicillin-resistant Staphylococcus Aureus carriers. In this group, prophylactic intravenous antibiotics was also administered at TDC insertion and topical antibiotics were applied to the exit site post-insertion. Patients were educated on TDC care and this was reinforced prior to discharge. Early CRBSI was defined as any new bacteremia occurring within 30 days of TDC insertion, and the rate of CRBSI was compared between the intervention and control groups.
Results
308 TDC insertions or exchanges were performed during the study period (153 in intervention group and 155 in control group), of which there were 18 (5.8%) episodes of early CRBSI. Microbiological profile includes gram positive (8 episodes, 44.4%), gram negative (7 episodes, 38.9%), polymicrobial (2 episodes, 11.1%) and fungal (1 episode, 5.6%) organisms. In the intervention group, early CRBSI occurred in 5 (3.3%) TDC insertions while early CRBSI occurred in 13 (8.4%) TDC insertions in the control group, with a trend towards significance (p = 0.056). The interventions were well tolerated and cost effective, with the project resulted in significant healthcare cost savings.
Conclusion
The frequency of early CRBSI was successfully decreased, with a trend towards significance, using a comprehensive bundle of interventions. Further follow-up with regards to CRBSI frequency and analysis on the effectiveness of individual interventions would be helpful in assessing the utility of these measures.