Multifaceted interventions may prevent hemodialysis catheter-related bloodstream infection
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Key takeaways:
- Two randomized trials reported discordant intervention effects.
- Results highlight a need for further study to verify the effectiveness of multifaceted quality improvement interventions.
Multifaceted quality improvement interventions may prevent hemodialysis catheter-related bloodstream infections outside the ICU, however, more research is needed, according to published data.
In the systematic review, a team of researchers from Monash University, The George Institute of Global Health and the University of New South Wales, studied the implementation multifaceted quality improvement interventions to prevent hemodialysis catheter-related bloodstream infections in patients using a central venous catheter for hemodialysis outside the ICU, compared to usual care.
The review included 21 studies identified from a search of PubMed, Embase and the Cochrane Central Register of Controlled Trials. The studies included randomized trials, time-series analyses and before-after studies examining the effect of multifaceted interventions on the incidence of hemodialysis catheter-related bloodstream infections or access-related bloodstream infections, according to the study. Two researchers assessed the risk of bias and quality of evidence. Intervention effects, validity and characteristics of studies with the same design were compared, and studies were included in the final analysis only if the design participants required hemodialysis via a central venous catheter. Among the 15 studies that measured hemodialysis catheter-related bloodstream infections, two randomized trials reported discordant intervention effects, according to the study. Two interrupted time-series analyses showed positive interventions and 11 before-after studies reported favorable results as well, with a very high risk of bias.
“The overall quality of evidence was low for [hemodialysis catheter-related bloodstream infections] HDCRBSI and very low for [access-related bloodstream infections] ARBSI,” Benjamin Lazarus, MBBS, a nephrologist at the Department of Medicine, Monash University, wrote in the study.
Overall, researchers said the results highlight the need for further study to verify the effectiveness of multifaceted quality improvement interventions in preventing hemodialysis catheter-related bloodstream infections among hemodialysis patients outside of the ICU.
While some evidence may be favorable, the researchers wrote, “the quality of evidence is low, and more carefully conducted studies are needed to confirm their effectiveness.”
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