Implementation of a continuous quality improvement program reduces the occurrence of peritonitis in PD

Abstract

Objective: To investigate the causes of peritonitis in patients with peritoneal dialysis (PD) using continuous quality improvement (CQI) to develop effective interventions and reduce the occurrence of peritonitis. Methods: A quality control team consisting of 10 members, including the department head, four nephrologists and four nurses, all specialized in PD care, and the head nurse, was established at the Peritoneal Dialysis Center of the Third Xiangya Hospital of Central South University. All patients with peritonitis occurring between 1 July 2010 and 31 December 2011 (pre-CQI period) were analyzed and compared with data obtained between January 2012 (implementation of CQI) and March 2013 to investigate possible causes of peritonitis and to develop corresponding interventions. Fishbone analysis, including laboratory parameters, was carried out monthly. Results: Gastrointestinal tract dysfunction, nonstandard procedures and malnutrition were found to be the top three risk factors for peritonitis. Gastrointestinal tract dysfunction was the likely cause of peritonitis in 42.8% of the subjects before CQI and 36.0% after CQI (p50.05). Nonstandard procedures were the cause of peritonitis in 33.3% of the subjects before CQI and 24.0% after CQI (p50.05). The overall incidence of peritonitis reduced from once every 40.1 patient months before the CQI to once every 70.8 patient months after CQI (p50.05). The incidence of Grampositive bacteria peritonitis reduced from once every 96.9 patients per month before CQI to once every 209.1 patient months after CQI (p50.05), whereas the incidence of Gram-negative bacteria peritonitis reduced from once every 234.2 patient months before CQI to once every 292.8 patient months after CQI. Conclusion: CQI can effectively reduce the occurrence of PD-related peritonitis.

Economic Impact of a Peritoneal Dialysis Continuous Quality Improvement Program in Colombia

“…For example Yu and others reported that a PD CQI program improved the rate of peritonitis from 1 episode in 22.2 patient-months to 1 episode in 30.1 patient-months in the first year after implementation and, subsequently, to 1 episode in 71.1 and 77.3 patient-months in years 2 and 3, respectively (16). Wang and others reported a reduction in the incidence of peritonitis from 1 in every 40.1 patient-months before the CQI to once every 70.8 patient-months after CQI (15). The PD CQI program described in this study did not differ substantially in its components from other PD CQI programs that have been described in the literature (11,(14)(15)(16).…”

“…Wang and others reported a reduction in the incidence of peritonitis from 1 in every 40.1 patient-months before the CQI to once every 70.8 patient-months after CQI (15). The PD CQI program described in this study did not differ substantially in its components from other PD CQI programs that have been described in the literature (11,(14)(15)(16). While these types of programs exist elsewhere, they have not previously been examined for economic impact.…”

“…Yu and others reported that a continuous quality improvement (CQI) program improved patient survival (16). However, more information is needed to understand whether such programs can consistently reduce peritonitis rates (15). Further, it is not known whether the cost of such programs exceeds the additional costs and resource utilization associated with peritonitis.…”

“…Patient education and training about optimal techniques for PD is one way to help prevent peritonitis. Targeted programs to improve the quality of PD and prevent peritonitis have been effective (11)(12)(13)(14)(15). Yu and others reported that a continuous quality improvement (CQI) program improved patient survival (16).…”

ISPD Catheter-Related Infection Recommendations: 2017 Update

“…If a pattern of infections develops, the team should investigate and plan interventions to rectify the problem. Observational data suggest that CQI programs reduce peritonitis rates and improve technique survival (17,(153)(154)(155). However, none of these studies reported catheter-related infection as an outcome measure.…”