Reducing Early Catheter-Related Bloodstream Infection in Haemodialysis Patients

Introduction

Catheter-related bloodstream infection (CRBSI) occurs commonly in patients using a tunneled dialysis catheter (TDC) for vascular access. This results in additional investigations and invasive procedures, increased length of stay and increased mortality.

Methods

We undertook a continuous practice improvement project (CPIP) in selected wards to reduce the rates of early CRBSI in patients who required a new insertion or guidewire exchange of a TDC from April to September 2017. Early CRBSI was defined as any new bacteremia occurring within 1 month of catheter insertion.

We instituted a bundle of measures to reduce CRBSI in two designated wards as part of our CPIP project. Chlorhexidine bath was implemented prior to TDC insertion. Nasal decolonization was performed for Methicillin-resistant Staphylococcus Aureus carriers. Prophylactic intravenous antibiotics were given at catheter insertion and topical antibiotics were applied to the exit site post-insertion. Patients were educated on TDC care and this was reinforced prior to discharge.

Results

A total of 308 TDC insertions or exchanges were performed and 17 of these were complicated by early CRBSI. Of these, 8 episodes involved gram positive organisms, 7 episodes involved gram negative organisms, 1 was polymicrobial and 1 was fungal. In the intervention group, early CRBSI occurred in 5 of 153 TDC insertions. In the control group which did not receive the intervention, early CRBSI occurred in 12 of 155 TDC insertions. Chi-squared test performed showed a trend towards significance with p = 0.086.

Conclusion

A comprehensive bundle of measures instituted was able to reduce the frequency of early CRBSI and showed a definite trend towards significance. Further follow-up with regards to CRBSI frequency and analysis on the effectiveness of individual interventions would be helpful in assessing the utility of these measures.