COVID-19 hygienic procedures reduce catheter-related infections at hemodialysis centers
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Researchers from Italy observed a “drastic” reduction in central venous catheter-related infections after hygienic procedures were implemented at hemodialysis facilities as a response to the COVID-19 pandemic.
“Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to completely avoid the occurrence of [central venous catheter] CVC-related infections,” Marco Heidempergher, of the nephrology unit at ASST Fatebenefratelli Sacco in Milan, and colleagues wrote. “During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced.”
Using data from two hemodialysis units affiliated with the University of Milan (a total of 215 patients; 33% used a CVC), Heidempergher and colleagues compared catheter-related infection rates during the “maximum spread” of the pandemic (defined as February to May 2020) with infection rates from those months in the previous year, as well as from 2019 in its entirety.
“Infection rates drastically decreased during the COVID-19 pandemic, with just one catheter-related bloodstream infection being recorded,” the researchers wrote, observing a 91% reduction in catheter-related bloodstream infections compared with February to May 2019 and an 83% reduction when they compared rates to the whole of 2019.
“We hypothesize that the health care staff, the nurses and doctors, facing such a dramatic event changed their approach [toward] the way they work,” Heidempergher and colleagues suggested. “The level of attention was maximized. Fear of spread of contagion of COVID-19 among patients and health care workers maximized the effectiveness of common patient care with regard to the prevention of other infections.”
According to Heidempergher and colleagues, the reduction in infection rates is likely due to this increased attention and “stringent” hygienic standards, including use of surgical masks, more frequent hand washing, use of hand sanitizer, elimination of the mid-dialysis snacks and elimination of blankets.
“This study lends support to the concept that significant reductions in the current CVC-related infection rates among patients undergoing hemodialysis are achievable,” they concluded.
“COVID-19 may have reminded us of one of the most basic lesson in medicine: hygiene first.”
Perspective
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Deborah Brouwer-Maier, RN, CNN
The recent publication entitled “Targeting COVID‑19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter‑related infections” by Heidempergher and colleagues found a 91% reduction in catheter-related bloodstream infections during the COVID-19 pandemic precautions months of February to May 2020 compared with the same timeframe in 2019. This study should spark more investigation by the global renal community.
Key points in the article include the following:
- Surgical masks are worn by both the patient and the nurse when manipulating the catheter;
- Increase utilization of proper hand hygiene by patients and nurses;
- Patients and nurses were prohibited from snacking during the dialysis session;
- Use of blankets was eliminated; and
- Increased sanitization of the treatment area.
The first point of clarification to the authors is the question of mask utilization. In the United States, everyone's continuous wearing of a mask was implemented inside the treatment area as part of the COVID-19 increased infection control measures. Is this the same as in the study locations?
The use of a mask for catheter manipulations was first recommended as part of the 1997 NKF DOQI Vascular Access Guidelines to reduce catheter‑related infections. I was one of two nursing representatives on the DOQI Work Group, and I was the one who championed mask utilization. The identification of Staphylococcus aureus and MRSA had recently been documented in the nasal passages for both hemodialysis patients and dialysis staff members. In my opinion, the adoption of mask utilization for catheter manipulations was a significant improvement in routine catheter care. If the COVID-19 infection control precautions included the universal masking for all patients and staff at all times in the treatment area, this could be a factor in the observed decrease in the infection rate in the study timeframes. The elimination of snacking would prevent the removal of the masks within the treatment area.
The second point of clarification is the elimination of blankets. In the United States, most dialysis providers require patients to bring blankets from home for each treatment. The laundering of the blankets is also the patient's responsibility. It is not noted in the study if the blankets were facility supplied or patient supplied. Patients' practice of providing their blankets may need to be investigated to determine if the blankets may be a source of the infection spread.
COVID-19 infection control precautions may also impact the spread of seasonal flu. Current CDC trends show the 2020 fall season trending lower than the fall 2019 timeframe.
Global takeaways from this study include the long-term adoption of improved hand hygiene by patients and staff (handwashing and use of hydroalcoholic hand sanitizer) and the improved sanitation of the treatment areas.
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