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Abstract: TH-PO271

Multifaceted Interventions to Prevent Haemodialysis Catheter-Related Bloodstream Infections Outside the Intensive Care Unit: A Systematic Review and Meta-Analysis

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access


  • Lazarus, Ben, Monash University, Clayton, Victoria, Australia
  • Bongetti, Elisa K., Monash University, Clayton, Victoria, Australia
  • Ling, Jonathan E.H., Monash Health, Clayton, Victoria, Australia
  • Gallagher, Martin P., The George Institute for Global Health, Newtown, New South Wales, Australia
  • Kotwal, Sradha S., The George Institute for Global Health, Newtown, New South Wales, Australia
  • Polkinghorne, Kevan, Monash University, Clayton, Victoria, Australia

Central venous catheters (CVCs) are widely used for haemodialysis access, but frequently lead to burdensome and costly bloodstream infections. It is unclear whether haemodialysis catheter-related bloodstream infections (HDCRBSI) or access-related bloodstream infections (ARBSI) can be prevented through multifaceted interventions. We sought to determine whether the implementation of a multifaceted intervention in ambulatory haemodialysis services can prevent HDCRBSI or ARBSI compared to usual care.


We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to 23rd April 2022 using a sensitive keyword search strategy (PROSPERO CRD42021252290). All randomized trials, interrupted time series (ITS), and before-after studies that examined the effect of multifaceted interventions on incidence of HDCRBSI or ARBSI were included. Two authors independently extracted data and assessed risk of bias and quality of evidence using validated tools. Random effects meta-analysis of the intervention effect was planned for HDCRBSI and ARBSI outcomes.


We evaluated 8824 non-duplicate citations, 117 full texts and included 20 unique studies, of which 15 assessed HDCRBSI and 5 assessed ARBSI only. Among the eight HDCRBSI studies eligible for meta-analysis, two cluster randomized trials had conflicting results, two ITS studies reported an effective intervention but with conflicting patterns of effect, and all four before-after studies reported a favourable effect with serious risk of bias. None of the ARBSI studies were eligible for meta-analysis. The overall GRADE of evidence for an intervention effect on HDCRBSI and ARBSI was very low.


Most studies report a favourable effect of multifaceted interventions on HDCRBSI, but the quality of evidence is very low and studies with lower risk of bias showed less or no effect. Further high-quality studies are warranted.


  • Government Support – Non-U.S.