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Habihirwe P, Marini H, Wurtz B, Vermeulin T, Lottin M, Gehanno JF, Boulet L, Vergnes H, Edet S, Guet L, Le Roy F, Merle V. Compliance with good practice guidelines for the prevention of vascular access infections: the multi-centre PHYDEL survey in French haemodialysis units. J Hosp Infect 2023; 142:1-8. [PMID: 37734680 DOI: 10.1016/j.jhin.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND French guidelines for the prevention of vascular access infections in a haemodialysis setting were released in 2005. Compliance with these guidelines is currently unknown. The aim of this study was to assess compliance with the guidelines for vascular access infection prevention in French haemodialysis units, and to describe the difficulties reported. METHODS A cross-sectional survey was conducted between March and December 2019 in 200 haemodialysis units in France, selected at random. Data were collected via questionnaire, completed by telephone interview with an infection control practitioner. A practice was deemed compliant when >85% of units declared that they always complied with the guidelines. RESULTS In total, 103 units (51.5%) agreed to participate. Most practices complied with the guidelines; however, some practices did not reach the 85% compliance threshold for working in pairs when connecting central venous catheter (CVC) lines, performing hand hygiene before disconnecting lines, rinsing antiseptic soap before painting CVC exit site or arteriovenous fistula (AVF) puncture site, allowing antiseptic paint to dry, handling CVC branches with antiseptic impregnated gauze, performing hand hygiene after AVF compression with gloves, wearing protective eyewear when connecting/disconnecting CVC or when puncturing AVF, and wearing a gown when puncturing AVF. The most frequently reported difficulties were understaffing, difficulties with skin preparation because of exit site skin damage, and lack of buttonhole technical expertise. CONCLUSIONS Despite good overall compliance, this survey highlights some shortcomings in compliance with infection prevention guidelines, which could be associated with either higher risk of vascular access infection or increased blood-borne virus transmission.
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Affiliation(s)
- P Habihirwe
- Department of Infection Control, CHU Rouen, Rouen, France
| | - H Marini
- Department of Infection Control, CHU Rouen, Rouen, France; Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France
| | - B Wurtz
- Department of Infection Control, CHU Rouen, Rouen, France; Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France; REIN Registry, Agence de Biomédecine, Paris, France
| | - T Vermeulin
- Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France; Comprehensive Cancer Centre Henri Becquerel, UNICANCER, Rouen, France
| | - M Lottin
- Department of Infection Control, CHU Rouen, Rouen, France; Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France
| | - J F Gehanno
- Department of Occupational Health, CHU Rouen, Rouen, France
| | - L Boulet
- Department of Infection Control, CHU Rouen, Rouen, France; Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France
| | | | - S Edet
- REIN Registry, Agence de Biomédecine, Paris, France; Department of Nephrology and Haemodialysis, CHU Rouen, Rouen, France; ANIDER Rouen Normandie, Rouen, France
| | - L Guet
- CPIAS Normandie, Rouen, France
| | - F Le Roy
- Department of Nephrology and Haemodialysis, CHU Rouen, Rouen, France
| | - V Merle
- Department of Infection Control, CHU Rouen, Rouen, France; Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France; REIN Registry, Agence de Biomédecine, Paris, France.
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2
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Hussein WF, Ahmed G, Browne LD, Plant WD, Stack AG. Evolution of Vascular Access Use among Incident Patients during the First Year on Hemodialysis: A National Cohort Study. KIDNEY360 2021; 2:955-965. [PMID: 35373090 PMCID: PMC8791378 DOI: 10.34067/kid.0006842020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/21/2021] [Indexed: 11/27/2022]
Abstract
Background Although the arteriovenous fistula (AVF) confers superior benefits over central venous catheters (CVCs), utilization rates remain low among prevalent patients on hemodialysis (HD). The goal of this study was to determine the evolution of vascular access type in the first year of dialysis and identify factors associated with conversion from CVC to a functioning AVF. Methods We studiedadult patients (n=610) who began HD between the January 1, 2015 and December 31, 2016 and were treated for at least 90 days, using data from the National Kidney Disease Clinical Patient Management System in the Irish health system. Prevalence of vascular access type was determined at days 90 and 360 after dialysis initiation and at 30-day intervals. Multivariable logistic regression explored factors associated with CVC at day 90, and Cox regression evaluated predictors of conversion from CVC to AVF on day 360. Results CVC use was present in 77% of incident patients at day 90, with significant variation across HD centers (from 63% to 91%, P<0.001), which persisted after case-mix adjustment. From day 90 to day 360, AVF use increased modestly from 23% to 41%. Conversion from CVC to AVF increased over time, but the likelihood was lower for older patients (for age >77 years versus referent, adjusted hazard ratio [HR], 0.43; 95% CI, 0.19 to 0.96), for patients with a lower BMI (per unit decrease in BMI, HR, 0.95; 95% CI, 0.93 to 0.98), and varied significantly across HD centers (from an HR of 0.25 [95% CI, 0.08 to 0.74] to 2.09 [95% CI, 1.04 to 4.18]). Conclusion CVCs are the predominant type of vascular access observed during the first year of dialysis, with low conversion rates from CVC to AVF. There is substantial center variation in the Irish health system that is not explained by patient-related factors alone.
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Affiliation(s)
- Wael F Hussein
- School of Medicine, University of Limerick, Limerick, Ireland.,Department of Nephrology, University Hospital Limerick, Limerick, Ireland
| | - Gasim Ahmed
- School of Medicine, University of Limerick, Limerick, Ireland.,Department of Nephrology, University Hospital Limerick, Limerick, Ireland
| | - Leonard D Browne
- School of Medicine, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - William D Plant
- Department of Nephrology, Cork University Hospital, Cork, Ireland.,National Renal Office, Health Service Executive Clinical Programmes and Strategy Division, Dublin, Ireland
| | - Austin G Stack
- School of Medicine, University of Limerick, Limerick, Ireland.,Department of Nephrology, University Hospital Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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Porazko T, Stasiak E, Klinger M. The Impact of the Introduction of Innovative REDS Scale for the Evaluation of Central Tunnelled Catheter (CTC) Exit Site on Infection Prevention in Long-Term Haemodialyzed Patients. Front Surg 2021; 8:629367. [PMID: 33898506 PMCID: PMC8062969 DOI: 10.3389/fsurg.2021.629367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Central tunneled catheter (CTC)-related infections are a leading cause of a catheter loss, thus being the source of significant morbidity and mortality. The study aims at evaluating the impact of the implementation of the innovative redness, edema, discharge and tenderness, symptoms (REDS) scale (devised by the authors) for the description of the tunnel condition on the frequency of infection in long-term catheter users. The same cohort of the 40 patients was observed for 4 years altogether: 2 years before and 2 years after REDS application. The results, as well as follow-up evaluation of participants, were compared. The 2-year cumulative incidence of the CTC exit site infection (ESI) dropped significantly (log-rank p < 0.001) from 0.89 episode/1,000 catheter days (53.5%, 95% CI [35.9%; 66.2%]) in the period before REDS was used—to 0.26 episode/1,000 catheter days (18.6%, 95% CI [6.1%; 29.4%]) in the time of REDS application. There were also significantly fewer episodes of ESI complicated with catheter-related blood stream infection (CRBSI) requiring the CTC removal (0.6 episode/1,000 catheter days; 18.6%, 95% CI [6.1%; 29.4%] vs. 0.3 episode/1,000 catheter days; 4.7%, 95% CI [0.0; 10.7%]; log-rank p = 0.04, in pre-REDS and REDS time, respectively). The REDS scale appears to be a simple, cost-effective tool reducing the frequency of the tunneled CTC exit site infection and associated bloodstream infections.
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Affiliation(s)
- Tomasz Porazko
- Department of Internal Medicine and Nephrology, Institute of Medical Sciences, University of Opole, Opole, Poland.,Department of Nephrology and Dialysis Unit, University Hospital Opole, Opole, Poland
| | - Edyta Stasiak
- Department of Nephrology and Dialysis Unit, University Hospital Opole, Opole, Poland.,Doctoral School, Silesian Medical University, Katowice, Poland
| | - Marian Klinger
- Department of Internal Medicine and Nephrology, Institute of Medical Sciences, University of Opole, Opole, Poland.,Department of Nephrology and Dialysis Unit, University Hospital Opole, Opole, Poland
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Loomba G, Dhandapani M, Kaur S, Ghai S, Biswal M, Ramachandran R, Gupta KL. The Effectiveness of Personal Hygiene Practices on Non-Cuffed Central Vein Catheter-Related Infection in Patients Undergoing Hemodialysis: A Randomized Controlled Trial. Indian J Nephrol 2019; 29:267-271. [PMID: 31423061 PMCID: PMC6668307 DOI: 10.4103/ijn.ijn_92_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Infection of the internal jugular vein (IJV) catheter continues to be a common cause of death in patients with end-stage renal disease undergoing hemodialysis (HD). The present study aimed to evaluate the effectiveness of personal hygiene on the incidence of IJV catheter-related bloodstream infection (CRBSI). A randomized, controlled, parallel, and non-inferiority trial was conducted on patients initiated on maintenance HD via right IJV catheter. Patients were randomly allocated to control and intervention group via computer-generated random table. Intervention package for the intervention group included hand washing (2–4 hourly and whenever visibly dirty), feet washing (12 hourly), and axillary shave (at any point during the study, no hair growth in axilla). Patients were provided with a pamphlet and reinforced to continue package till IJV catheter was in situ. Patients were followed up twice a week for one month from the date of catheter insertion for the incidence of CRBSI. The primary outcome of the study was percentage of patients free from CRBSI. On intention-to-treat analysis, the percentage of patients without CRBSI was 53.7% and 29.3% in the intervention and control arm, respectively [P = 0.04; 25.12% (1.43–45.28%)]. Positive blood cultures were higher in control (73.3%) as compared to the intervention group (28.6%) (P = 0.19). Personal hygiene interventions are an effective method to reduce the incidence of CRBSIs among population undergoing maintenance HD via non-cuffed IJV catheter.
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Affiliation(s)
| | | | - Sukhpal Kaur
- National Institute of Nursing Education, Chandigarh, India
| | - Sandhya Ghai
- National Institute of Nursing Education, Chandigarh, India
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Alhazmi SM, Noor SO, Alshamrani MM, Farahat FM. Bloodstream infection at hemodialysis facilities in Jeddah: a medical record review. Ann Saudi Med 2019; 39:258-264. [PMID: 31381376 PMCID: PMC6838644 DOI: 10.5144/0256-4947.2019.258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bloodstream infections (BSI) are a major complication of hemodialysis. The risk of infection among hemodialysis patients is usually associated with the dialysis procedure itself, specifically the means of vascular access. OBJECTIVES Estimate the rate of BSI and assess factors possibly associated with BSI. DESIGN Analytical retrospective medical record review. SETTING Hemodialysis unit in a tertiary care center. PATIENTS AND METHODS Adult patients (18-60 years old) who had hemodialysis as first renal replacement therapy in the 20-month period from January 2014 to August 2016 were included in this study. Demographic and clinical characteristics were used in a multivariate logistic regression to assess factors that might be associated with BSI. MAIN OUTCOME MEASURES The rate of BSI and associated factors among chronic hemodialysis outpatients. SAMPLE SIZE AND CHARACTERISTICS 160 outpatients on hemodialysis, median (IQR) age 47.7 (37.0-56.0) years, males (60.6%). RESULTS The rate of BSI was 0.4 per 100 patient-months. Multivariate logistic regression revealed that patients who had central venous catheters had the highest risk for BSI (odds ratio: 10.088; 95% CI= 2.595-39.215; P=.001) compared with arteriovenous fistulas. Gram-negative bacteria were isolated in 54.6% of cases, with coagulase-negative Staphylococcus the most frequent isolate (18.2%), followed by Klebsiella pneumoniae and Enterobacteriaceae (15.2%, each). CONCLUSIONS The type of vascular access type is the main risk factor associated with BSI in hemodialysis patients. The arteriovenous fistula, which has a lower infection rate compared to the catheter, is the best available option for hemodialysis patients. LIMITATIONS Retrospective, single center and relatively small sample size. CONFLICT OF INTEREST None.
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Affiliation(s)
| | - Samah Omar Noor
- From the Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majid Mousa Alshamrani
- From the Infection Prevention and Control, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh and Jeddah, Saudi Arabia
| | - Fayssal Mostafa Farahat
- From the Infection Prevention and Control, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh and Jeddah, Saudi Arabia
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Mohamed H, Ali A, Browne LD, O'Connell NH, Casserly L, Stack AG, Hussein WF. Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study. BMC Nephrol 2019; 20:68. [PMID: 30808313 PMCID: PMC6390569 DOI: 10.1186/s12882-019-1253-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background Infections are the second leading cause of death and hospitalisation among haemodialysis (HD) patients. Rates of access-related bloodstream infections (AR-BSI) are influenced by patient characteristics and local protocols. We explored factors associated with AR-BSI in a contemporary cohort of HD patients at a tertiary nephrology centre. Methods A retrospective cohort of 235 chronic HD patients was identified from a regional dialysis programme between Jan 2015 and Dec 2016. Data on demographics, primary renal disease, comorbid conditions and dialysis access type were obtained from the Kidney Disease Clinical Patient Management System (KDCPMS). Data on blood cultures were captured from the microbiology laboratory. Poisson regression with robust variance estimates was used to compare infection rates and relative risk of AR-BSI according to the site and type of vascular access. Results The mean age was 65 (± 15) years, 77% were men, and the median follow up was 19 months (IQR: 10–24 months), accumulating 2030 catheter-months and 1831 fistula-months. Overall rates of AR-BSI were significantly higher for central venous catheter (CVC) compared to arteriovenous fistula (AVF), (2.22, 95% (CI): 1.62–2.97) versus 0.11 (0.01–0.39) per 100 patient-months respectively), with a rate ratio of 20.29 (4.92–83.66), p < 0.0001. This pattern persisted across age, gender and diabetes subgroups. Within the CVC subgroup, presence of a femoral CVC access was associated with significantly higher rates of AR-BSI (adjusted RR 4.93, 95% CI: 2.69–9.01). Older age (75+ versus < 75 years) was not associated with significant differences in rates of AR-BSI in the unadjusted or the adjusted analysis. Coagulase negative Staphylococcus (61%) and Staphylococcus aureus (23%) were the predominant culprits. AR-BSIs resulted in access loss and hospitalisation in 57 and 72% of events respectively, and two patients died with concurrent AR-BSI. Conclusions Rates of AR-BSI are substantially higher in CVC than AVF in contemporary HD despite advances in catheter design and anti-infective protocols. This pattern was consistent in all subgroups. The policy of AVF preference over CVC should continue to minimise patient morbidity while at the same time improving anti-infective strategies through better care protocols and infection surveillance. Electronic supplementary material The online version of this article (10.1186/s12882-019-1253-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Husham Mohamed
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Alaa Ali
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Leonard D Browne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Division of Microbiology, Department of Medicine, University Hospital Limerick, Limerick, Ireland
| | - Liam Casserly
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Austin G Stack
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland. .,Graduate Entry Medical School, University of Limerick, Limerick, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Wael F Hussein
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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7
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Hussein WF, Mohammed H, Browne L, Plant L, Stack AG. Prevalence and correlates of central venous catheter use among haemodialysis patients in the Irish health system - a national study. BMC Nephrol 2018; 19:76. [PMID: 29609535 PMCID: PMC5880000 DOI: 10.1186/s12882-018-0873-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 03/15/2018] [Indexed: 11/28/2022] Open
Abstract
Background Central venous catheters (CVC) are associated with substantial morbidity and mortality among patients undergoing haemodialysis (HD), yet they are frequently used as the primary vascular access for many patients on HD. The goal of this study was to determine the prevalence and variation in CVC use across centres in the Irish health system. Methods Data from the National Kidney Disease Clinical Patient Management System (KDCPMS) was used to determine CVC use and patterns across centres. Data on demographic characteristics, primary cause of end-stage kidney disease (ESKD), comorbid conditions, laboratory values and centre affiliation were extracted for adult HD patients (n = 1, 196) who were on dialysis for at least three months up to end of December 2016. Correlates of CVC use were explored using multivariable logistic regression. Results Overall prevalence of CVC use was 54% and varied significantly across clinical sites from 43% to 73%, P < 0.001. In multivariate analysis, the likelihood of CVC use was lower with increasing dialysis vintage, OR 0.40 (0.26–0.60) for 4 years vs 1 year vintage, rising serum albumin, OR 0.73 (0.59–0.90) per 5 g/L), and with cystic disease as a cause of ESKD, OR 0.38 (95% CI 0.21–0.6). In contrast, catheter use was greater for women than men, OR 1.77 (1.34–2.34) and for 2 out of 10 regional dialysis centres, OR 1.98 (1.02–3.84) and OR 2.86 (1.67–4.90) respectively compared to referent group). Conclusions Catheters are the predominant type of vascular access in patients undergoing HD in the Irish health system. Substantial centre variation exists which is not explained by patient-level characteristics. Electronic supplementary material The online version of this article (10.1186/s12882-018-0873-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wael F Hussein
- Department of Nephrology, University Hospital Limerick, St Nessans Rd, Dooradoyle, Limerick, Ireland. .,Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Husham Mohammed
- Department of Nephrology, University Hospital Limerick, St Nessans Rd, Dooradoyle, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Leonard Browne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Liam Plant
- National Renal Office, HSE Clinical Programmes and Strategy Division, Dublin, Ireland.,Department of Renal Medicine, University College Cork, Cork, Ireland
| | - Austin G Stack
- Department of Nephrology, University Hospital Limerick, St Nessans Rd, Dooradoyle, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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Barriers to Adopting a Fistula-First Policy in Europe: An International Survey among National Experts. J Vasc Access 2014; 16:113-9. [DOI: 10.5301/jva.5000313] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study is to explore how vascular access care was reimbursed, promoted, and organised at the national level in European and neighbouring countries. Methods An electronic survey among national experts to collect country-level data. Results Forty-seven experts (response rate, 76%) from 37 countries participated. Experts from 23 countries reported that 50% or less of patients received routine pre-operative imaging of vessels. Nephrologists placed catheters and created fistulas in 26 and 8 countries, respectively. Twenty-one countries had a fee per created access; the reported fee for catheter placement was never higher than for fistula creation. As the number of haemodialysis patients in a centre increased, more countries had a dedicated coordinator or multidisciplinary team responsible for vascular access maintenance at the centre-level; in 11 countries, responsibility was always with individual nephrologists, independent of a centre's size. In 23 countries, dialysis centres shared vascular access care resources, with facilitation from a service provider in 4. In most countries, national campaigns (n = 35) or educational programmes (n = 29) had addressed vascular access-related topics; 19 countries had some form of training for creating fistulas. Forty experts considered the current evidence base robust enough to justify a fistula-first policy, but only 13 believed that more than 80% of nephrologists in their country would attempt a fistula in a 75-year-old woman with comorbidities. Conclusions Suboptimal access to surgical resources, lack of dedicated training of clinicians, limited routine use of pre-operative diagnostic imaging and patient characteristics primarily emerged as potential barriers to adopting a fistula-first policy in Europe.
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