Nosocomial Infections in Dialysis Access

Abstract

Nosocomial infections in patients requiring renal replacement therapy have a high impact on morbidity and mortality. The most dangerous complication is bloodstream infection (BSI) associated with the vascular access, with a low BSI risk in arteriovenous fistulas or grafts and a comparatively high risk in central venous catheters. The single most important measure for preventing BSI is therefore the reduction of catheter use by means of early fistula formation. As this is not always feasible, prevention should focus on educational efforts, hand hygiene, surveillance of dialysis-associated events, and specific measures at and after the insertion of catheters. Core measures at the time of insertion include choosing the optimal site of insertion, the use of maximum sterile barrier precautions, adequate skin antisepsis, and the choice of catheter type; after insertion, access care needs to ensure hub disinfection and regular dressing changes. The application of antimicrobial locks is reserved for special situations. Evidence suggests that bundling a selection of the aforementioned measures can significantly reduce infection rates. The diagnosis of central lineassociated BSI (CLABSI) is based on clinical signs and microbiological findings in blood cultures ideally drawn both peripherally and from the catheter. The prompt installation of empiric antibiotic treatment covering the most commonly encountered organisms is key regarding CLABSI treatment. Catheter removal is recommended in complicated cases or if cultures yield Staphylococcus aureus , enterococci, Pseudomonas or fungi. In other cases, guide wire exchange or catheter salvage strategies with antibiotic lock solutions may be acceptable alternatives.

Surveillance of Dialysis Events: one-year experience at 33 outpatient hemodialysis centers in China

“…HD patients are often in immunocompromised status and require frequent or long-term vascular access and they are therefore at risk for developing infections of the vascular access site and bloodstream infections (BSI) 6–8 . BSI and localized infections of the vascular access site cause substantial morbidity and mortality in HD patients 9, 10 .…”

Risk factors associated with nosocomial infections among end stage renal disease patients undergoing hemodialysis: A systematic review

“…Patients with two or more catheter sites or longer catheterization duration are significantly more likely to have nosocomial infections than those with one catheter site and shorter catheterization duration [17,39,40]. Catheter related infection (CRIs) in HD patients is one of the major causes of increased morbidity, mortality, and cost of therapy [41][42][43]. The most effective prevention strategy for these infections is to reduce the use of catheters [44].…”

“…The most effective prevention strategy for these infections is to reduce the use of catheters [44]. Efforts should be made through patient education and vascular access coordinator to reduce the use of catheters by identifying and addressing barriers to permanent vascular access placement and catheter removal [45]. Centers for disease control (CDC) has also recommended other interventions such as hand hygiene, patient and staff education and skin antisepsis to decrease the risk of these infections [46].…”

Surface modification strategies for hemodialysis catheters to prevent catheter‐related infections: A review

“…Approximately 30–40% of chronic HD patients depend on central venous catheters 7 . CVCs, which can be divided as permanent (tunneled) or temporary (non‐tunneled) HD catheters and cuffed or non‐cuffed HD catheters, 8 are preferred for HD patients in whom the use of AVF and AVG is not suitable, for example when the renal system deteriorates quickly, since AVF needs a maturation time before it is fully functional 9 …”

“…7 CVCs, which can be divided as permanent (tunneled) or temporary (non-tunneled) HD catheters and cuffed or non-cuffed HD catheters, 8 are preferred for HD patients in whom the use of AVF and AVG is not suitable, for example when the renal system deteriorates quickly, since AVF needs a maturation time before it is fully functional. 9 Venous access for HD catheters is applied through 3 veins in the body. 10 Two of them, subclavian vein and jugular vein, are in the upper chest.…”