Implementing nasal povidone-iodine decolonization to reduce infections in hemodialysis units: a qualitative assessment

Abstract

Background: A substantial proportion of patients undergoing hemodialysis carry Staphylococcus aureus in their noses, and carriers are at increased risk of S. aureus bloodstream infections. Our pragmatic clinical trial implemented nasal povidone-iodine (PVI) decolonization for the prevention of bloodstream infections in the novel setting of hemodialysis units. Objective: We aimed to identify pragmatic strategies for implementing PVI decolonization among patients in outpatient hemodialysis units. Design: Qualitative descriptive study. Setting: Outpatient hemodialysis units affiliated with five US academic medical centers. Units varied in size, patient demographics, and geographic location. Interviewees: Sixty-six interviewees including nurses, hemodialysis technicians, research coordinators, and other personnel. Methods: We conducted interviews with personnel affiliated with all five academic medical centers and conducted thematic analysis of transcripts. Results: Hemodialysis units had varied success with patient recruitment, but interviewees reported that patients and healthcare personnel (HCP) found PVI decolonization acceptable and feasible. Leadership support, HCP engagement, and tailored patient-focused tools or strategies facilitated patient engagement and PVI implementation. Interviewees reported both patients and HCP sometimes underestimated patients’ infection risks and experienced infection-prevention fatigue. Other HCP barriers included limited staffing and poor staff engagement. Patient barriers included high health burdens, language barriers, memory issues, and lack of social support. Conclusion: Our qualitative study suggests that PVI decolonization would be acceptable to patients and clinical personnel, and implementation is feasible for outpatient hemodialysis units. Hemodialysis units could facilitate implementation by engaging unit leaders, patients and personnel, and developing education for patients about their infection risk.