Consistent compliance with standardized hemodialysis care reduces infection risk
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Dialysis-related infections become less of a risk when dialysis centers consistently improve compliance with standardized hemodialysis care practices, according to findings published in the American Journal of Kidney Disease.
“The Children’s Hospital Association’s Standardizing Care to Improve Outcomes in Pediatric ESKD (SCOPE) Collaborative is a multicenter quality transformation effort aimed to minimize infectious complications among children on maintenance dialysis through implementation of standardized care practices,” Rebecca L. Ruebner, MD, MSCE, from the division of pediatric nephrology at Johns Hopkins University School of Medicine, and colleagues wrote. “Previous studies of SCOPE’s hemodialysis project have focused on infection rates at a collaborative-wide level. The primary aim of this study was to describe the epidemiology of and identify patient-level risk factors for hemodialysis-associated infections in children.”
In a prospective cohort study, researchers evaluated 1,277 children from 35 pediatric dialysis centers enrolled in SCOPE between June 2013 and July 2019. Researchers assessed patient and center data before categorizing centers as consistent, dynamic or inconsistent performers based on frequency of compliance with hemodialysis care practices over time.
Using a multivariable, generalized linear mixed model, researchers measured patient-level risk factors that correlated with increased rates of catheter-associated bloodstream infections (CA-BSI) per 100 patient-months. The primary outcome of this study was the identification of catheter-associated bloodstream infections.
Analyses revealed 1,018 of the patients had a catheter and 259 had an arteriovenous fistula or graft. Mupirocin use at catheter exit site or no antibiotic use at catheter exit site were considered as risk factors associated with increased CA-BSI rates among patients with a catheter. The median compliance with hemodialysis catheter care practice among centers was 87.5%, and dynamic performing centers declined in CA-BSI rates over time (2.71 to 0.71 per 100 patient months). There was no significant change in CA-BSI rates among consistent or inconsistent performers.
“In summary, dialysis-associated BSI are an important complication among children with ESKD and are associated with significant morbidity,” Ruebner and colleagues wrote. "Consistent improvement in compliance with standardized hemodialysis care practices can lead to a reduction in the risk of dialysis-associated infections among children with end-stage kidney disease.”
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