Standardized surveillance of hemodialysis vascular access infections: 18-month experience at an outpatient, multifacility hemodialysis center

Epidemiology of hemodialysis vascular access infections from longitudinal infection surveillance data: predicting the impact of NKF-DOQI clinical practice guidelines for vascular access

National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Vascular Access Guidelines 29 (40% of prevalent patients should have a native fistula) and 30 (<10% use of catheters for chronic hemodialysis) are currently based on opinion, rather than published evidence. The impact of these guidelines on reducing vascular access infection rates is unknown and was tested using data from an outpatient prospective cohort analysis. Patients undergoing hemodialysis from January 1998 through December 2000 at six outpatient facilities in Idaho and Oregon were evaluated prospectively for vascular access infections. There were 111,383 dialysis sessions (DSs) with 471 infections identified (4.2 infections/1,000 DSs). The risk for infection relative to arteriovenous (AV) fistulae was highly dependent on type of access used: 2.2 (P = 0.002) for AV grafts, 13.6 (P < 0.0001) for tunneled catheters, and 32.6 (P < 0.0001) for temporary catheters. Based on incidence infection rates, the number of infections predicted to occur with implementation of guidelines 29 and 30 in this population was calculated, and the percentage of reduction in infection was determined. Following either guideline 29 or 30 alone would have predictably prevented 103 or 97 total infections (22% and 21% reduction) and 40 or 51 bloodstream infections (24% and 30% reduction), respectively. Following both guidelines simultaneously would have prevented 151 total infections (32% reduction) and 64 bloodstream infections (38% reduction). These epidemiological data firmly establish that a major risk for vascular access infections is the type of access used (temporary catheters > tunneled catheters > AV grafts > AV fistulae). Furthermore, they strongly support the role of these NKF-DOQI guidelines in preventing infectious complications attributed to vascular access.

A new concept of plaster for preventing hand-borne infections

A new plaster has been developed to improve asepsis in current medical and nursing care. Technical improvements were achieved via a no touch' technique. The experimental protocol used to evaluate this new plaster allows us to claim its evident superiority because of the no touch' principle and rapid application. Such a plaster appears to be very helpful in diminishing the incidence of hand-borne infections during medical and nursing care.

Infections associated with dialysis and transplantation

Infection within the abdominal wall and peritonitis are still important causes of morbidity which ultimately limit the use of peritoneal dialysis in end-stage renal failure. Similarly disastrous complications resulting in loss of access can follow infection in venous cannulae and artificial arteriovenous fistulae, particularly in synthetic vascular grafts. Important publications continue to underline the mechanism of reduced resistance to infection by uraemic patients. After renal transplantation bacterial infection is common and predictable. However, immunosuppressed recipients are particularly susceptible to viral and fungal infection. Arguably infection of all types can induce organ rejection.