Abstract: SU-OR30
Association Between Antimicrobial Barrier Cap Use and Outcomes Among Hemodialysis Patients Using a Central Venous Catheter
Session Information
- Peritoneal Dialysis and Vascular Access: Research Abstracts
October 25, 2020 | Location: Simulive
Abstract Time: 05:00 PM - 07:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Sibbel, Scott, Davita Clinical Research, Minneapolis, Minnesota, United States
- Hunt, Abigail, Davita Clinical Research, Minneapolis, Minnesota, United States
- Van Wyck, David B., DaVita Inc, Denver, Colorado, United States
- Jordan, Lysa, Davita Clinical Research, Minneapolis, Minnesota, United States
- Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States
- Nissenson, Allen R., DaVita Inc, Denver, Colorado, United States
- Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
Background
Bloodstream infections (BSIs) are a common complication of central venous catheter (CVC) use and contribute to hospitalization, mortality, and high costs of care in patients on hemodialysis (HD). In a prior randomized clinical trial, patients using CVCs with antimicrobial barrier caps (AmBC; ClearGuard® HD, Pursuit Vascular Inc, Maple Grove, MN, USA) had significantly lower catheter-related BSI rates compared to patients using CVCs with the historical standard of care. Based on these findings, AmBCs were introduced in May 2019 as standard of care for CVC patients across a large dialysis organization (LDO). This study assessed changes in clinical outcomes in a real-world HD population following implementation of AmBC use.
Methods
Study data were derived from LDO electronic medical records over two 3-month periods: Pre (Jul-Oct 2018) and Post (Jul-Oct 2019) AmBC adoption. Included patients were adults receiving in-center HD treatment 3x/week using a CVC. Crude outcome rates were calculated for individual calendar months and for the pre- and post-periods overall; formal comparisons were made using generalized linear models.
Results
A total of 37,642 patients in the pre-period and 40,498 patients in the post-period met eligibility criteria. Overall BSI rate fell from 0.54/100 CVC days in the pre-period to 0.36/100 CVC days after AmBC implementation. Hospitalization rates were lower during the post-period versus the pre-period overall and within each calendar month; the contribution of underlying temporal changes (eg, background year-over-year change) could not be quantified.
Conclusion
Adoption of AmBCs for use in HD patients using a CVC for vascular access was associated with an early 34% reduction in infections assessed on the basis of positive blood cultures and 0.22 fewer hospital admissions per patient-year.