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Published online before print February 22, 2018 , doi: 10.1681/ASN.2017080870

+ Author Affiliations

Correspondence:
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Abstract

Central venous catheters (CVCs) contribute disproportionately to bloodstream infection (BSI) and, by extension, to infection-related hospitalization, mortality, and health care costs in patients undergoing dialysis. Recent product advancements may reduce BSIs, but a sufficiently powered comparative-effectiveness study is needed to facilitate evidence-based patient care decisions. In a 13-month, prospective, cluster-randomized, open-label trial, we compared BSI rates in facilities using ClearGuard HD antimicrobial barrier caps (ClearGuard group) with those in facilities using Tego hemodialysis connectors plus Curos disinfecting caps (Tego+Curos group). Forty DaVita dialysis facilities in the United States were pair-matched by BSI rate, number of patients using CVCs, and geographic location, and then cluster randomized 1:1. We enrolled all adult patients undergoing dialysis with CVCs at these facilities, except those allergic to heparin or chlorhexidine. Overall, 1671 patients participated in the study, accruing >183,000 CVC-days. The study outcome was positive blood culture (PBC) rate as an indicator of BSI rate. We calculated results at the cluster level and adjusted for the facility cluster effect. During a 3-month run-in period immediately before study interventions, the groups had similar BSI rates ( P =0.8). During the 13-month intervention period that immediately followed, the ClearGuard group had a BSI rate significantly lower than that of the Tego+Curos group (0.28 versus 0.75 PBCs per 1000 CVC-days, respectively; P =0.001). No device-related adverse events were reported. In conclusion, compared with Tego connectors plus Curos caps, ClearGuard HD antimicrobial barrier caps significantly lowered the rate of catheter-related BSIs in patients undergoing hemodialysis using CVCs, representing an important advancement in hemodialysis patient care.

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Central venous catheters (CVCs) are used in only 19% of dialysis procedures in the United States, but are responsible for 70% of vascular access–related bloodstream infections (BSIs). 1 In addition, BSI is the second leading cause of death among patients undergoing hemodialysis who use CVCs for their vascular access. Devices are now available that may significantly reduce BSI rates. However, comparative effectiveness data for these devices have not been available to allow evidence-based patient care decisions.

BMJ article that assesses the efficacy of different antibacterial regimens and non-antibacterial alternatives in the prevention of recurrent uncomplicated urinary tract infections in women.

Catheter associated urinary tract

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Information, guidance and case studies to help prevent catheter-associated urinary tract infections.

Catheter care: Royal College of Nursing guidance opens in a new window

Publication aiming to encourage widespread adoption of the National Occupational Standards across all NHS and independent healthcare sectors, by enabling a full understanding of the standards and providing quality care for patients.

NICE clinical guidance: Clinical audit tool - catheter maintenance (CG139) opens in a new window

Use as a starting point for a local clinical audit project that aims to reduce infection by improving catheter maintenance.

Skin or soft tissue

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An improvement resource for health professionals and patients to access current information for the benefit of all at risk of pressure ulcers.

The management of patients with venous leg ulcers opens in a new window

RCN report that provides a reference for health professionals requiring information about current recommendations on the assessment and management of leg ulcers.

Wound management products and elasticated garment opens in a new window

Suggestions for choices of primary dressing depending on the type of wound.

Intravascular associated infection

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This document has been developed to support the care of adult patients undergoing infusion therapies.

Surgical site infections

Surgical site infection surveillance service (SSISS) opens in a new window

This service allows hospitals to record incidents of infection after surgery, track patient results and review or change practice to avoid further infections.

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