Catheter care strategies help reduce sepsis in dialysis patients

By Anne Harding

NEW YORK (Reuters Health) - The catheter care strategies recommended by the Centers for Disease Control and Prevention (CDC) do reduce bloodstream infections and intravenous antibiotic use in hemodialysis patients, according to a new study by the largest dialysis provider in the U.S.

When used for vascular access, central venous catheters (CVCs) increase the risk of infection, Dr. Eduardo Lacson of Fresenius Medical Care North America in Waltham, Massachusetts, and colleagues write in the American Journal of Kidney Diseases, online December 2.

"We need to reduce catheter-related infections and the primary strategy is to avoid using hemodialysis catheters, but there are going to be patients that require their use, so we also need to develop strategies that will minimize infection in those patients that are already using the catheter," Dr. Lacson explained in an interview with Reuters Health. While the CDC has recommended strategies for reducing infections, he added, these strategies have often not been evaluated in this patient group.

In the current study, Dr. Lacson and his team investigated whether implementing two CDC-recommended approaches -- scrubbing the hub of the catheter and using a chlorhexidine swab around the catheter exit site -- as a quality improvement intervention would reduce bloodstream infection risk.

They compared rates of BSIs for the three months before the intervention was implemented and for the three months following the first month of implementation. They matched 422 facilities by region, facility size, and rate of positive blood cultures, and then randomized the pairs to the intervention or usual care.

While rates of bloodstream infections were similar at baseline, they were reduced after the implementation (0.81/1,000 CVC days in the implementation group vs. 1.04/1,000 CVC days in the control group, p=0.02). Intravenous antibiotic starts were 2.53/1,000 CVC days in the intervention group versus 3.15/1,000 CVC days in the control group (p<0.001). Regression analysis found a 21% to 22% reduction in both outcomes.

During an additional nine months of follow-up, sepsis rates remained low, at 0.50/1,000 CVC days. During the full year of follow-up, hospitalization rates for sepsis were 0.19/1,000 CVC days for the intervention group versus 0.26/1,000 CVC days for the control group (p<0.05).

Plans are underway to "spread" the QI intervention to all of the company's facilities, Dr. Lacson noted, but that plan has been delayed since the CDC put forth additional recommendations for preventing bloodstream infections. He and his colleagues plan to investigate whether implementing some of these new approaches in addition to the two already studied will result in further improvement.

SOURCE: http://bit.ly/1l7JaJY

Am J Kidney Dis 2013.

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