Exit-Site Care in Austrian Peritoneal Dialysis Centers — a Nationwide Survey

Abstract

Background Catheter-associated infections markedly contribute to treatment failure in peritoneal dialysis (PD) patients. There is much controversy surrounding prophylactic strategies to prevent these infections. Methods In this nationwide multicenter study we analyzed strategies to prevent catheter-associated infections as performed in Austrian PD centers in 2006. A questionnaire was sent to all 23 PD centers in Austria. Results Ten different catheter models were used in the 332 patients being treated in the 23 Austrian PD centers. Systemic antibiotics prior to catheter placement were given by 17 of the 23 PD centers (glycopeptides, n = 7; cephalosporins, n = 10). Nasal swabs were taken preoperatively by 17 PD centers; nasal Staphylococcus aureus carriers were treated prophylactically with mupirocin cream in 15 of these centers. Dressing change was routinely performed in 318 of 332 chronic PD patients (nonocclusive film dressing, n = 58; gauze dressing, n = 260). Disinfectants for chronic exit-site care included povidone iodine ( n = 155), sodium hypochlorite ( n = 31), povidone iodine + sodium hypochlorite together ( n = 102), and octenidine dihydrochloride/phenoxyethanol ( n = 17). Water+non-disinfectant soap or 0.9% sodium chloride was administered as a cleansing agent to the exit site by 27 patients. Routine S. aureus screening (nasal and/or exit-site swabs) in chronic PD patients was performed in 12 PD centers; carriers were treated with mupirocin cream in 11 of these centers. Dialysis staff members were screened for S. aureus in 8 PD centers and spouses were screened for S. aureus in 5 PD centers. The overall exit-site infection rate was 1 episode/43.9 patient-months, tunnel infection rate was 1 episode/88.9 patient-months, and peritonitis rate was 1 episode/51.0 patient-months. Patients of centers that have installed a prophylaxis protocol for treating S. aureus carriers had lower mean infection rates compared with those not using such a protocol. Conclusion Various individual prophylactic strategies are used to prevent catheter-associated infections in Austrian PD centers. Infection rates are within the range reported in the literature. There is still scope for improvement in some centers ( e.g., by establishing a prophylaxis protocol).

Comparison between types of dressing following catheter insertion and early exit‐site infection in peritoneal dialysis

“…The most frequently used covering in Brazil was found to be occlusive dressings, in contrast to the results found by an Austrian nationwide survey, in which gauze dressings were more frequently used (Kopriva-Altfahrt et al 2009), and also in Australia (Ibels et al 1997). This type of dressing is often chosen, as it can remain in place for longer periods of time, decreases skin irritation, provides a greater comfort from the patient's point of view and decreases the material costs and need for nursing staff (Bender et al 2006).…”

Focus on peritoneal dialysis training: working to decrease peritonitis rates

“…Data relating to peritonitis rates among units from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) reported a 10-fold variation in 2003-08 [13] and a 3-fold variation in 2011 [1]. Similar findings were reported from multi-centre analyses in the UK (7-fold variation) [14], Scotland (5-fold variation) [15] and Austria (20-fold variation) [16]. It is likely that such substantial variations in PD peritonitis are at least partly related to variable attention paid by centres to potentially modifiable peritonitis risk factors [17], including patient training [10].…”

Peritonitis outcomes in patients with HIV and end-stage renal failure on peritoneal dialysis: a prospective cohort study

“…However, peritonitis presents an ongoing challenge and is a major cause of technical failure [ 4 – 6 ], particularly under poor socioeconomic conditions and in immunocompromised patients [ 7 , 8 ]. Considerable advancement has been made in CAPD management over the last decades leading to a substantial decrease in peritonitis rates, with as few as 1 case/51 patient–months reported by some authors [ 9 ]. However, peritonitis remains an important factor influencing CAPD-associated morbidity and mortality, and certain organisms, such as fungi and Gram-negative bacteria, are associated with worse outcomes [ 10 – 12 ].…”